ES2861258T3 - Circumferential Shot Surgical Stapler - Google Patents
Circumferential Shot Surgical Stapler Download PDFInfo
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- ES2861258T3 ES2861258T3 ES19180055T ES19180055T ES2861258T3 ES 2861258 T3 ES2861258 T3 ES 2861258T3 ES 19180055 T ES19180055 T ES 19180055T ES 19180055 T ES19180055 T ES 19180055T ES 2861258 T3 ES2861258 T3 ES 2861258T3
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- RUFVGSGZCHLQTE-ZCFIWIBFSA-N OC1=C=C=C[C@@H]1CCS Chemical compound OC1=C=C=C[C@@H]1CCS RUFVGSGZCHLQTE-ZCFIWIBFSA-N 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0641—Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07221—Stapler heads curved
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
- A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
Una grapadora quirúrgica (10), que comprende: un ensamblaje de mango (12) conectado a un ensamblaje de cartucho de grapadora (14); el ensamblaje de cartucho de grapadora tiene un efector terminal (18) en el extremo distal; el efector terminal comprende una mandíbula superior (48) conectada a una mandíbula inferior (50) de forma tal que la mandíbula superior se puede mover a través del ensamblaje de mango respecto a la mandíbula inferior entre una configuración abierta y una configuración cerrada; la mandíbula inferior tiene una superficie superior (114) y la mandíbula superior tiene una superficie de yunque; en donde en la configuración cerrada, un hueco (5a) se define entre la superficie superior y la superficie de yunque para recibir tejido (8a) a ser grapado; la mandíbula inferior incluye además múltiples canales (53) de grapas 10 dispuestos longitudinalmente a lo largo de la longitud de la mandíbula inferior y configurados para recibir grapas (54, 100, 254, 300, 310); y que además incluye múltiples grapas (54) dispuestas dentro de los canales (53); y en donde el accionamiento de la grapadora en el ensamblaje de mango mueve las grapas desde una configuración no deformada dentro del canal (53) de grapas contra la superficie de yunque hacia una configuración deformada para grapar tejido ubicado en el hueco (5a); cada canal (53) de grapa tiene una abertura en la superficie superior; en 15 donde cuando la mandíbula superior (48) y la mandíbula inferior (50) están en la configuración cerrada una sección transversal tomada perpendicular al eje longitudinal del efector terminal y vista desde un extremo forma una sección transversal sustancialmente circular que define un punto central y línea media, pasando a través de dicho punto central y perpendicular a la superficie superior de la mandíbula inferior, en donde más de una línea de grapas se definen en cualquiera de los lados de la línea media mediante múltiples aberturas alineadas a lo largo de la longitud 20 longitudinal de la superficie superior; caracterizado por uno o más canales (53) de grapas son curvos en la sección transversal tomada perpendicular al eje longitudinal del efector terminal formando una vía de suministro circunferencial para una grapa y cada canal de grapa (53) en la misma línea de grapa tiene la misma curvatura y cada grapa (54, 100, 254, 300, 310) tiene patas curvas que se confirman a la curvatura de los canales de grapa en los que residen.A surgical stapler (10), comprising: a handle assembly (12) connected to a stapler cartridge assembly (14); the stapler cartridge assembly has an end effector (18) at the distal end; The end effector comprises an upper jaw (48) connected to a lower jaw (50) such that the upper jaw is movable through the handle assembly relative to the lower jaw between an open configuration and a closed configuration; the lower jaw has an upper surface (114) and the upper jaw has an anvil surface; wherein in the closed configuration, a gap (5a) is defined between the upper surface and the anvil surface to receive tissue (8a) to be stapled; The lower jaw further includes multiple staple channels (53) arranged longitudinally along the length of the lower jaw and configured to receive staples (54, 100, 254, 300, 310); and that further includes multiple staples (54) arranged within the channels (53); and wherein actuation of the stapler in the handle assembly moves the staples from an undeformed configuration within the staple channel (53) against the anvil surface to a deformed configuration for stapling tissue located in the gap (5a); Each staple channel (53) has an opening in the top surface; wherein when the upper jaw (48) and lower jaw (50) are in the closed configuration a cross section taken perpendicular to the longitudinal axis of the end effector and viewed from one end forms a substantially circular cross section defining a central point and midline, passing through said central point and perpendicular to the upper surface of the lower jaw, where more than one line of staples are defined on either side of the midline by multiple openings aligned along the length 20 longitudinal of the upper surface; characterized by one or more staple channels (53) are curved in cross section taken perpendicular to the longitudinal axis of the end effector forming a circumferential supply path for a staple and each staple channel (53) in the same staple line has the same curvature and each staple (54, 100, 254, 300, 310) has curved legs that are confirmed by the curvature of the staple channels in which they reside.
Description
DESCRIPCIÓNDESCRIPTION
Grapadora quirúrgica con disparo circunferencialCircumferential Shot Surgical Stapler
Campo de la InvenciónField of Invention
Esta divulgación se refiere a instrumentos quirúrgicos y, más particularmente, a instrumentos de grapado quirúrgicos para aplicar múltiples grapas quirúrgicas al tejido corporal.This disclosure relates to surgical instruments and, more particularly, to surgical stapling instruments for applying multiple surgical staples to body tissue.
Antecedentes de la InvenciónBackground of the Invention
Un aparato grapador quirúrgico típico comprende un mango en un extremo proximal y dos miembros tipo mandíbula alargados en el extremo distal, unidos en una bisagra. Los miembros tipo mandíbula se articulan para abrir y cerrar para capturar tejido entre los miembros tipo mandíbula. El usuario controla el dispositivo desde el mango para abrir y cerrar los miembros tipo mandíbula, accionar el despliegue de grapas y, en general, manipular y controlar el dispositivo. Uno de los miembros de mandíbula porta un cartucho que contiene grapas dispuestas en una o más filas. El otro de los miembros tipo mandíbula comprende una superficie de yunque contra la cual las grapas son accionadas para deformar las patas de la grapa. Las grapas son expulsadas del cartucho por una superficie de leva o deslizador que se mueve longitudinalmente contra múltiples pulsadores posicionados lateralmente que presionan cada grapa hacia afuera del cartucho. La superficie de leva del deslizador está inclinada para complementar la superficie angular de los pulsadores. Algunas grapas incluyen una cuchilla que sigue a la superficie de leva de manera que corta el tejido entre las dos o más filas de grapas suministradas. Ejemplos de tales grapadoras quirúrgicas se pueden encontrar en los documentos de patent que tienen los números de publicación US 5,389,098 A, WO 02/096327 A2 y US 2012/080498 A1A typical surgical stapling apparatus comprises a handle at a proximal end and two elongated jaw-like members at the distal end, joined at a hinge. The jaw-like limbs hinge open and close to capture tissue between the jaw-like limbs. The user controls the device from the handle to open and close the jaw-like members, actuate staple deployment, and generally manipulate and control the device. One of the jaw members carries a cartridge containing staples arranged in one or more rows. The other of the jaw-like members comprises an anvil surface against which the staples are actuated to deform the legs of the staple. Staples are ejected from the cartridge by a longitudinally moving cam or slider surface against multiple laterally positioned pushers that press each staple out of the cartridge. The cam surface of the slider is sloped to complement the angular surface of the pushbuttons. Some staples include a blade that follows the cam surface so that it cuts tissue between the two or more rows of supplied staples. Examples of such surgical staplers can be found in patent documents having publication numbers US 5,389,098 A, WO 02/096327 A2 and US 2012/080498 A1
Las grapas quirúrgicas son utilizadas en una variedad de técnicas quirúrgicas que incluyen procedimientos quirúrgicos laparoscópicos y/o endoscópicos u otros mínimamente invasivos en los que la grapadora se inserta a través de una cánula o tubo posicionado dentro de una pequeña incisión en un cuerpo de un paciente. En cirugía laparoscópica mínimamente invasiva, se inserta un trocar en el tejido corporal de un paciente para acceder a una cavidad corporal y para crear un canal para la inserción de una cámara, tal como un laparoscopio. La cámara proporciona un video en vivo que captura imágenes que luego son transmitidas para el cirujano en uno o más monitores de video. Los trocares adicionales se insertan para crear vías adicionales a través de las cuales instrumentos quirúrgicos, que incluyen grapadoras quirúrgicas, se pueden insertar para realizar procedimientos observados en el monitor de video. La ubicación de tejido dirigida tal como el abdomen, normalmente se agranda al administrar gas de dióxido de carbono para insuflar la cavidad corporal y crear un espacio de trabajo lo suficientemente grande para alojar el periscopio e instrumentos utilizados por el cirujano. La presión de insuflación en la cavidad tisular se mantiene al utilizar trocares especializados que tienen sellos que previenen que el gas de insuflación se escape y colapse el espacio de trabajo quirúrgico. La cirugía laparoscópica ofrece una cantidad de ventajas cuando se compara con un procedimiento abierto. Estas ventajas incluyen disminución del dolor y pérdida de sangre y tiempos de recuperación más cortos.Surgical staples are used in a variety of surgical techniques including laparoscopic and / or endoscopic or other minimally invasive surgical procedures in which the stapler is inserted through a cannula or tube positioned within a small incision in a patient's body. . In minimally invasive laparoscopic surgery, a trocar is inserted into the body tissue of a patient to access a body cavity and to create a channel for the insertion of a camera, such as a laparoscope. The camera provides live video that captures images that are then transmitted to the surgeon on one or more video monitors. Additional trocars are inserted to create additional pathways through which surgical instruments, including surgical staplers, can be inserted to perform procedures observed on the video monitor. The targeted tissue location such as the abdomen is normally enlarged by administering carbon dioxide gas to inflate the body cavity and create a workspace large enough to accommodate the periscope and instruments used by the surgeon. Insufflation pressure in the tissue cavity is maintained by using specialized trocars that have seals that prevent the insufflation gas from escaping and collapsing the surgical workspace. Laparoscopic surgery offers a number of advantages when compared to an open procedure. These benefits include decreased pain and blood loss and shorter recovery times.
Como la cirugía laparoscópica evoluciona para convertirse incluso más mínimamente invasiva con incisiones y diámetros de trocar/cánula que se tornan cada vez más pequeños, las grapadoras quirúrgicas para uso en procedimientos laparoscópicos, mínimamente invasivos deben diseñarse para ajustarse dentro del pequeño lumen de una cánula. En general, una grapadora quirúrgica se inserta en una cánula con los miembros tipo mandíbula en una orientación cerrada hasta que las mandíbulas del dispositivo se encuentren dentro del paciente donde se abren los miembros tipo mandíbula para sujetar y grapar tejido. El mango de la grapadora se encuentra por fuera del paciente controlado por el usuario cirujano. Una parte del eje de la grapadora entre los miembros tipo mandíbula y el mango es lo suficientemente larga para extenderse desde afuera del paciente hacia dentro del paciente. Durante el procedimiento de grapado, el eje alargado de la grapadora se encuentra dentro de la cánula en la cual se insertó. As laparoscopic surgery evolves to become even more minimally invasive with incisions and trocar / cannula diameters becoming smaller and smaller, surgical staplers for use in laparoscopic, minimally invasive procedures must be designed to fit within the small lumen of a cannula. In general, a surgical stapler is inserted into a cannula with the jaw-like members in a closed orientation until the jaws of the device are within the patient where the jaw-like members open to clamp and staple tissue. The handle of the stapler is located outside the patient controlled by the surgeon user. A portion of the stapler shaft between the jaw-like members and the handle is long enough to extend from outside the patient into the patient. During the stapling procedure, the elongated shaft of the stapler is within the cannula into which it was inserted.
Los miembros tipo mandíbula distales incluyen varios componentes tales como un yunque para formar grapas, un cartucho de grapas con múltiples grapas, una superficie de leva, un deslizador, pulsadores, una cuchilla y otros componentes que deben ser todos lo suficientemente pequeños para ajustarse a través de una cánula de diámetro pequeño y estar hechos para funcionar de forma confiable y repetida desde afuera del paciente. Como se muestra en la Figura 1A, cuando se cierran, los miembros tipo mandíbula de la grapadora quirúrgica 2a tienen una sección transversal sustancialmente circular en donde aproximadamente la mitad de la sección transversal comprende la mandíbula inferior 3a que aloja las grapas 7a.The distal jaw members include various components such as an anvil for forming staples, a staple cartridge with multiple staples, a cam surface, a slider, pushers, a blade, and other components that must all be small enough to fit through. of a small diameter cannula and be made to function reliably and repeatably from outside the patient. As shown in Figure 1A, when closed, the jaw-like members of the surgical stapler 2a have a substantially circular cross-section where approximately half of the cross-section comprises the lower jaw 3a that houses the staples 7a.
Aproximadamente un poco menos que la otra mitad de la sección transversal comprende la mandíbula superior 4a que aloja el yunque. La sección transversal circular de la mandíbula distal incluye un hueco 5a entre las mandíbulas superior e inferior para recibir tejido a ser grapado. En la Figura 1A, una línea vertical 6a divide la sección transversal a la mitad y representa una línea de cuchilla o una viga en I que porta una cuchilla para cortar entre una o más filas de grapas 7a. La viga en I se desliza longitudinalmente a lo largo de la longitud del extremo distal y también funciona para presionar las grapas 7a para afuera de la mandíbula inferior 3a, a lo largo del hueco 5a y contra el yunque de la mandíbula superior 4a. Múltiples líneas verticales 7a en la Figura 1A representan tres líneas de grapas 7a verticalmente dispuestas que residen en la mandíbula inferior 3a en cualquiera de los lados de la línea de cuchilla 6a. El diseño de la grapadora convencional implica eyectar las grapas perpendicularmente contra la superficie de yunque.About slightly less than the other half of the cross section comprises the upper jaw 4a which houses the anvil. The circular cross section of the distal jaw includes a gap 5a between the upper and lower jaws to receive tissue to be stapled. In Figure 1A, a vertical line 6a divides the cross section in half and represents a blade line or an I-beam carrying a blade for cutting between one or more rows of staples 7a. The I-beam slides longitudinally along the length of the distal end and also functions to press the staples 7a out of the lower jaw 3a, along the gap 5a and against the anvil of the upper jaw 4a. Multiple vertical lines 7a in Figure 1A represent three vertically arranged staple lines 7a residing in the lower jaw 3a on either side of blade line 6a. The design of the Conventional stapler involves ejecting the staples perpendicularly against the anvil surface.
Mientras las grapadoras laparoscópicas convencionales tienen un diámetro de aproximadamente 12 milímetros, es deseable reducir el diámetro de la grapadora para encajar dentro de una cánula con un diámetro tan pequeño como aproximadamente 5-10 mm para realizar al paciente una incisión más pequeña, tiempo de recuperación reducido y cicatrización reducida. La Figura 1B ilustra una grapadora de diámetro reducido con el mismo diseño convencional como se muestra en la Figura 1A. Tal como se puede ver en la Figura 1B, la grapadora más pequeña 2b tiene un diámetro más pequeño con menos espacio para una mandíbula inferior 3b y una mandíbula superior 4b. El hueco de tejido 5b es aproximadamente el mismo que el hueco de tejido 5b de la grapadora más grande 2a para grapar tejido que tiene aproximadamente el mismo espesor. Como resultado del diámetro reducido y diseño convencional que eyecta grapas perpendicularmente contra la superficie de yunque, la grapadora más pequeña 2b aloja grapas 7b en la mandíbula inferior 3b que tienen patas de grapa más cortas como se muestra en la Figura 1B. La longitud SB de las patas de la grapa en la variación más pequeña de la Figura 1B es significativamente más corta que la longitud SA de las patas de la grapa en la variación más grande de la Figura 1A. Esta es una limitación inherente de la longitud de la pata de la grapa en grapadoras de diámetro más pequeño que emplean el mismo diseño convencional. Por lo tanto, es conveniente tener una grapadora de diámetro más pequeño que sea capaz de insertarse en cánulas más pequeñas mientras que al mismo tiempo retenga la misma capacidad de disparar grapas más grandes.While conventional laparoscopic staplers have a diameter of approximately 12 millimeters, it is desirable to reduce the diameter of the stapler to fit within a cannula with a diameter as small as approximately 5-10 mm to make the patient a smaller incision, recovery time reduced and reduced scarring. Figure 1B illustrates a reduced diameter stapler with the same conventional design as shown in Figure 1A. As can be seen in Figure 1B, the smaller stapler 2b has a smaller diameter with less room for a lower jaw 3b and an upper jaw 4b. The tissue gap 5b is approximately the same as the tissue gap 5b of the larger stapler 2a for stapling tissue having approximately the same thickness. As a result of the reduced diameter and conventional design that ejects staples perpendicularly against the anvil surface, the smaller stapler 2b houses staples 7b in the lower jaw 3b having shorter staple legs as shown in Figure 1B. The length SB of the staple legs in the smallest variation of Figure 1B is significantly shorter than the length SA of the staple legs in the largest variation of Figure 1A. This is an inherent limitation of staple leg length in smaller diameter staplers employing the same conventional design. Therefore, it is desirable to have a smaller diameter stapler that is capable of inserting into smaller cannulas while at the same time retaining the same ability to fire larger staples.
La Figura 2A ilustra tejido 8a que ha sido cortado a lo largo de una línea de cuchilla 6a y grapado con la grapadora convencional 2a de la Figura 1A. La Figura 2A muestra tres filas de grapas 7a suministradas en el tejido 8a adyacente a una línea de cuchilla 6a. Las otras tres filas de grapas 7a en el lado opuesto de la línea de cuchilla 6a se suministran en un segmento de tejido que se muestra en la Figura 2A. La distancia CA es la longitud de tejido 8a que ha sido grapado.Figure 2A illustrates tissue 8a that has been cut along a knife line 6a and stapled with the conventional stapler 2a of Figure 1A. Figure 2A shows three rows of staples 7a supplied in tissue 8a adjacent to a knife line 6a. The other three rows of staples 7a on the opposite side of the blade line 6a are supplied in a tissue segment shown in Figure 2A. The distance CA is the length of tissue 8a that has been stapled.
La Figura 2B ilustra tejido 8b que ha sido cortado a lo largo de una línea de cuchilla 6b y grapado con la grapadora convencional 2b de la Figura 1B que tiene un diámetro más pequeño respecto a la grapadora de la Figura 1A. La Figura 2B también muestra tres filas de grapas 7b suministradas en el tejido 8b adyacente a la línea de cuchilla 6b. La distancia CB es la longitud de tejido 8b que ha sido grapada. Cuando se compara con la longitud CA de la Figura 2A, la grapadora de diámetro más pequeño 2b produce una longitud más corta CB. La longitud CB es naturalmente más corta ya que las grapas 7b están colocadas de manera más estrecha en el área de la mandíbula inferior 3b reducida.Figure 2B illustrates tissue 8b that has been cut along a knife line 6b and stapled with the conventional stapler 2b of Figure 1B having a smaller diameter relative to the stapler of Figure 1A. Figure 2B also shows three rows of staples 7b supplied in tissue 8b adjacent to knife line 6b. Distance CB is the length of fabric 8b that has been stapled. When compared to the length CA of Figure 2A, the smaller diameter stapler 2b produces a shorter length CB. The length CB is naturally shorter as the staples 7b are positioned more closely in the reduced lower jaw area 3b.
Además, la longitud del manguito, que es la distancia entre la línea de cuchilla o borde del corte y la fila de grapas más cercana al borde del corte o línea de cuchilla, puede ser más corta ya que grapas más largas se colocan más cerca del diámetro como se muestra en la Figura 2B cuando se compara con la Figura 2A. Para que múltiples filas de grapas 7b encajen en una grapadora 2b de una versión de diámetro más pequeño, la grapadora 2b está configurada para suministrar una fila de grapas 7b lo más cerca posible a la línea de cuchilla 6b como se muestra en la Figura 2B. La proximidad de esta línea de grapas 7b suministradas está más cerca de la línea de cuchilla 6b que la misma línea de grapas 7a en la grapadora 2a de una versión más grande. La proximidad de grapas a la línea de cuchilla 6b puede aumentar las chances de que una grapa disparada erróneamente cruce la línea de cuchilla. Además, la proximidad de las grapas a la línea de cuchilla resulta en que la primera línea de grapas 7b se encuentre muy cerca del borde del tejido 8b que puede reducir la retención del tejido. Por lo tanto, es conveniente proporcionar una grapadora más pequeña que reduzca el riesgo de enganche de grapas y que proporcione más tejido entre la línea de la grapa y el borde del tejido.Also, the sleeve length, which is the distance between the knife line or edge of the cut and the row of staples closest to the edge of the cut or knife line, can be shorter as longer staples are placed closer to the diameter as shown in Figure 2B when compared to Figure 2A. In order for multiple rows of staples 7b to fit into a smaller diameter version stapler 2b, the stapler 2b is configured to supply a row of staples 7b as close as possible to the knife line 6b as shown in Figure 2B. The proximity of this supplied staple line 7b is closer to the knife line 6b than the same staple line 7a in the stapler 2a of a larger version. The proximity of staples to the blade line 6b can increase the chances that an erroneously fired staple will cross the blade line. Furthermore, the proximity of the staples to the blade line results in the first staple line 7b being very close to the edge of the tissue 8b which can reduce retention of the tissue. Therefore, it is desirable to provide a smaller stapler that reduces the risk of staple snagging and provides more tissue between the staple line and the edge of the tissue.
Para lograr los objetivos mencionados anteriormente, una grapadora de diámetro más pequeño que utiliza un diseño convencional puede requerir que el diseño incluya grapas más cortas u otros componentes de diseño. Por lo tanto, es conveniente tener una grapadora más pequeña sin sacrificar los objetivos mencionados anteriormente mientras que al mismo tiempo retenga la misma funcionalidad y eficacia en un diseño con diámetro más pequeño.To achieve the goals mentioned above, a smaller diameter stapler using a conventional design may require the design to include shorter staples or other design components. Therefore, it is convenient to have a smaller stapler without sacrificing the aforementioned objectives while at the same time retaining the same functionality and efficiency in a smaller diameter design.
Además, varios otros factores entran en la ecuación para una grapadora mejorada. Estos factores incluyen, de modo no taxativo, reducir la fuerza necesaria para suministrar grapas. Al reducir la fuerza de actuación mejora la precisión para que el cirujano requiera destreza en un procedimiento quirúrgico y también reduce la fatiga del cirujano. Normalmente, cuando las grapas se disparan perpendicularmente contra una superficie de yunque, las patas de la grapa son forzadas a torcerse.Additionally, several other factors enter the equation for an improved stapler. These factors include, but are not limited to, reducing the force required to deliver staples. Reducing the actuation force improves precision for the surgeon to require dexterity in a surgical procedure and also reduces surgeon fatigue. Normally, when the staples are fired perpendicularly against an anvil surface, the legs of the staple are forced to twist.
Otro factor que crea una mejor grapadora es la fuerza de la grapa deformada. Por ejemplo, la grapa deformada debe tener una grapa que incluya un espacio para recibir tejido sin comprimir o seccionar indebidamente el tejido en la ubicación de la grapa. Además, la forma deformada de la grapa debe ser lo suficientemente fuerte para soportar fuerzas que tenderían a abrir la grapa. En general, es un objetivo de la presente invención proporcionar una grapadora mejorada que retenga la funcionalidad y eficacia en una grapadora de diámetro reducida y línea de grapa resultante tomando en cuenta lo mencionado anteriormente así como otros factores de diseño. En cambio, es un objetivo de la presente invención proporcionar una grapadora que tenga el mismo diámetro que una grapadora quirúrgica convencional que pueda disparar grapas más largas con disparo circunferencial que anteriormente posible sin disparo circunferencial. Another factor that creates a better stapler is the strength of the warped staple. For example, the deformed staple must have a staple that includes a space to receive tissue without compressing or improperly sectioning the tissue at the location of the staple. Furthermore, the deformed shape of the staple must be strong enough to withstand forces that would tend to open the staple. In general, it is an object of the present invention to provide an improved stapler that retains functionality and efficiency in a reduced diameter stapler and resulting staple line taking into account the aforementioned as well as other design factors. Rather, it is an object of the present invention to provide a stapler having the same diameter as a conventional surgical stapler that can fire longer staples with circumferential firing than previously possible without circumferential firing.
Compendio de la InvenciónCompendium of the Invention
Según la presente invención se proporciona una grapadora quirúrgica tal como se menciona en la reivindicación 1. La grapadora emplea canales a través de los cuales las grapas de despliegan a lo largo de una vía en arco frente a una superficie de yunque. Los canales curvados invención permiten que las grapas con patas relativamente más largas sean utilizadas en la grapadora de la presente invención que tenga un diámetro más pequeño en las mandíbulas. Además, al utilizar una trayectoria curva, puede colocarse una grapa mucho más grande en el dispositivo del mismo diámetro. En determinadas realizaciones, una grapa hasta tres veces más grande puede emplearse en una grapadora de la presente invención. También se proporcionan las grapas curvas especializadas para uso con la grapadora de la presente invención. Para posibilitar tener adicionalmente los beneficios de la grapadora con canales de grapas curvos y el método de despliegue de las grapas, también se describen nuevas estructuras de reforzamiento de mandíbulas. Las estructuras de reforzamiento de mandíbulas de la grapadora pueden ubicarse hacia el centro o hacia la línea de cuchilla del dispositivo en lugar de alrededor de la circunferencia como en grapadoras convencionales, despejando, de este modo, el área exterior cerca de la circunferencia del dispositivo para dar cabida a grapas más largas y componentes de disparo de grapas.According to the present invention there is provided a surgical stapler as mentioned in claim 1. The stapler employs channels through which the staples are deployed along an arched path in front of an anvil surface. The curved channels of the invention allow staples with relatively longer legs to be used in the stapler of the present invention having a smaller diameter at the jaws. Also, by using a curved path, a much larger staple can be placed in the device of the same diameter. In certain embodiments, a staple up to three times larger can be used in a stapler of the present invention. Specialized curved staples for use with the stapler of the present invention are also provided. To further enable the benefits of the curved staple channel stapler and staple deployment method, new jaw reinforcing structures are also described. The jaw reinforcing structures of the stapler can be located towards the center or blade line of the device rather than around the circumference as in conventional staplers, thereby clearing the outer area near the circumference of the device to accommodate longer staples and staple firing components.
Breve descripción de los dibujosBrief description of the drawings
La Figura 1A es una vista esquemática transversal de un extremo distal de una grapadora quirúrgica convencional. Figure 1A is a schematic cross-sectional view of a distal end of a conventional surgical stapler.
La Figura 1B es una vista esquemática transversal de un extremo distal de una grapadora quirúrgica convencional con un diámetro más pequeño.Figure 1B is a schematic cross-sectional view of a distal end of a conventional surgical stapler with a smaller diameter.
La Figura 2A es una vista esquemática de sección superior de tejido con grapas que forman líneas de grapas suministradas con la grapadora de la Figura 1A.Figure 2A is a schematic top sectional view of tissue with staples forming staple lines supplied with the stapler of Figure 1A.
La Figura 2B es una vista esquemática de sección superior de tejido con grapas que forman líneas de grapas suministradas con la grapadora de la Figura 1B.Figure 2B is a schematic top sectional view of tissue with staples forming staple lines supplied with the stapler of Figure 1B.
La Figura 3 es una vista en perspectiva superior de una grapadora quirúrgica según la presente invención.Figure 3 is a top perspective view of a surgical stapler according to the present invention.
La Figura 4 es una vista lateral de un ensamblaje de cartucho para uso en una grapadora según la presente invención.Figure 4 is a side view of a cartridge assembly for use in a stapler in accordance with the present invention.
La Figura 5 es una vista lateral semitransparente de un extremo proximal de un ensamblaje de cartucho de grapadora para uso en una grapadora según la presente invención.Figure 5 is a semi-transparent side view of a proximal end of a stapler cartridge assembly for use in a stapler in accordance with the present invention.
La Figura 6 es una vista lateral de un eje accionador y deslizador de viga en I para uso en una grapadora según la presente invención.Figure 6 is a side view of an I-beam slider and drive shaft for use in a stapler in accordance with the present invention.
La Figura 7 es una vista en perspectiva superior de un deslizador de viga en I para uso en una grapadora según la presente invención.Figure 7 is a top perspective view of an I-beam slider for use in a stapler in accordance with the present invention.
La Figura 8 es una vista lateral de un deslizador de viga en I para uso en una grapadora según la presente invención.Figure 8 is a side view of an I-beam slider for use in a stapler in accordance with the present invention.
La Figura 9 es una vista superior de un deslizador de viga en I para uso en una grapadora según la presente invención.Figure 9 is a top view of an I-beam slider for use in a stapler in accordance with the present invention.
La Figura 10 es una vista inferior de un deslizador de viga en I para uso en una grapadora según la presente invención.Figure 10 is a bottom view of an I-beam slider for use in a stapler in accordance with the present invention.
La Figura 11 es una vista frontal de un deslizador de viga en I para uso en una grapadora según la presente invención.Figure 11 is a front view of an I-beam slider for use in a stapler in accordance with the present invention.
La Figura 12 es una vista posterior de un deslizador de viga en I para uso en una grapadora según la presente invención.Figure 12 is a rear view of an I-beam slider for use in a stapler in accordance with the present invention.
La Figura 13 es una vista en perspectiva superior semitransparente de un efector terminal con mandíbulas en una posición abierta para uso en una grapadora según la presente invención.Figure 13 is a semi-transparent top perspective view of an end effector with jaws in an open position for use in a stapler in accordance with the present invention.
La Figura 14 es una vista en perspectiva superior de un efector terminal con mandíbulas en una posición abierta para uso en una grapadora según la presente invención.Figure 14 is a top perspective view of an end effector with jaws in an open position for use in a stapler in accordance with the present invention.
La Figura 15 es una vista lateral de un efector terminal con mandíbulas en una posición abierta para uso en una grapadora según la presente invención.Figure 15 is a side view of an end effector with jaws in an open position for use in a stapler in accordance with the present invention.
La Figura 16 es una vista transversal semitransparente de un efector terminal con mandíbulas en una posición cerrada para uso en una grapadora según la presente invención. Figure 16 is a semi-transparent cross-sectional view of an end effector with jaws in a closed position for use in a stapler in accordance with the present invention.
La Figura 17 es una vista en perspectiva de un pulsador para uso en una grapadora según la presente invención. La Figura 18 es una vista lateral de un pulsador para uso en una grapadora según la presente invención.Figure 17 is a perspective view of a push button for use in a stapler in accordance with the present invention. Figure 18 is a side view of a push button for use in a stapler in accordance with the present invention.
La Figura 19 es una vista lateral de un pulsador para uso en una grapadora según la presente invención.Figure 19 is a side view of a push button for use in a stapler in accordance with the present invention.
La Figura 20 es una vista de extremo de un pulsador para uso en una grapadora según la presente invención. La Figura 21 es una vista de extremo de un pulsador para uso en una grapadora según la presente invención. La Figura 22 es una vista superior de un pulsador para uso en una grapadora según la presente invención. La Figura 23 es una vista inferior de un pulsador para uso en una grapadora según la presente invención.Figure 20 is an end view of a push button for use in a stapler in accordance with the present invention. Figure 21 is an end view of a push button for use in a stapler in accordance with the present invention. Figure 22 is a top view of a push button for use in a stapler in accordance with the present invention. Figure 23 is a bottom view of a push button for use in a stapler in accordance with the present invention.
La Figura 24 es una vista en perspectiva superior de una grapa para uso en una grapadora según la presente invención.Figure 24 is a top perspective view of a staple for use in a stapler in accordance with the present invention.
La Figura 25 es una vista lateral de una grapa para uso en una grapadora según la presente invención.Figure 25 is a side view of a staple for use in a stapler in accordance with the present invention.
La Figura 26 es una vista de extremo de una grapa para uso en una grapadora según la presente invención. La Figura 27 es una vista superior de una grapa para uso en una grapadora según la presente invención.Figure 26 is an end view of a staple for use in a stapler in accordance with the present invention. Figure 27 is a top view of a staple for use in a stapler in accordance with the present invention.
La Figura 28 es una vista en perspectiva superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 28 is a top perspective view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 29 es una vista lateral de una grapa deformada para uso en una grapadora según la presente invención. La Figura 30 es una vista de extremo de una grapa deformada para uso en una grapadora según la presente invención.Figure 29 is a side view of a deformed staple for use in a stapler in accordance with the present invention. Figure 30 is an end view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 31 es una vista en perspectiva superior de una grapa para uso en una grapadora según la presente invención.Figure 31 is a top perspective view of a staple for use in a stapler in accordance with the present invention.
La Figura 32 es una vista lateral de una grapa para uso en una grapadora según la presente invención.Figure 32 is a side view of a staple for use in a stapler in accordance with the present invention.
La Figura 33 es una vista de extremo de una grapa para uso en una grapadora según la presente invención. La Figura 34 es una vista en perspectiva superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 33 is an end view of a staple for use in a stapler in accordance with the present invention. Figure 34 is a top perspective view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 35 es una vista lateral de una grapa deformada para uso en una grapadora según la presente invención. La Figura 36 es una vista de extremo de una grapa deformada para uso en una grapadora según la presente invención.Figure 35 is a side view of a deformed staple for use in a stapler in accordance with the present invention. Figure 36 is an end view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 37 es una vista en perspectiva superior de una grapa para uso en una grapadora según la presente invención.Figure 37 is a top perspective view of a staple for use in a stapler in accordance with the present invention.
La Figura 38 es una vista lateral de una grapa para uso en una grapadora según la presente invención.Figure 38 is a side view of a staple for use in a stapler in accordance with the present invention.
La Figura 39 es una vista de extremo de una grapa para uso en una grapadora según la presente invención. La Figura 40 es una vista superior de una grapa para uso en una grapadora según la presente invención.Figure 39 is an end view of a staple for use in a stapler in accordance with the present invention. Figure 40 is a top view of a staple for use in a stapler in accordance with the present invention.
La Figura 41 es una vista en perspectiva superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 41 is a top perspective view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 42 es una vista lateral de una grapa deformada para uso en una grapadora según la presente invención. La Figura 43 es una vista superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 42 is a side view of a deformed staple for use in a stapler in accordance with the present invention. Figure 43 is a top view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 44 es una vista transversal, parcialmente transparente de un efector terminal para uso en una grapadora según la presente invención.Figure 44 is a partially transparent cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 45 es una vista transversal, parcialmente transparente de un efector terminal para uso en una grapadora según la presente invención.Figure 45 is a partially transparent cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 46 es una vista transversal, parcialmente transparente de un efector terminal para uso en una grapadora según la presente invención. Figure 46 is a partially transparent cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 47 es una vista transversal lateral de un efector terminal para uso en una grapadora según la presente invención.Figure 47 is a side cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 48 es una vista de sección superior de un efector terminal para uso en una grapadora según la presente invención.Figure 48 is a top sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 49 es una vista de sección, en perspectiva superior de un efector terminal para uso en una grapadora según la presente invención.Figure 49 is a sectional, top perspective view of an end effector for use in a stapler in accordance with the present invention.
La Figura 50 es una vista en perspectiva superior de una grapa de doble hilera para uso en una grapadora según la presente invención.Figure 50 is a top perspective view of a double row staple for use in a stapler in accordance with the present invention.
La Figura 51 es una vista lateral de una grapa de doble hilera para uso en una grapadora según la presente invención.Figure 51 is a side view of a double row staple for use in a stapler according to the present invention.
La Figura 52 es una vista de extremo de una grapa de doble hilera para uso en una grapadora según la presente invención.Figure 52 is an end view of a double row staple for use in a stapler in accordance with the present invention.
La Figura 53 es una vista superior de una grapa de doble hilera para uso en una grapadora según la presente invención.Figure 53 is a top view of a double row staple for use in a stapler in accordance with the present invention.
La Figura 54 es una vista en perspectiva superior de una grapa de doble hilera deformada para uso en una grapadora según la presente invención.Figure 54 is a top perspective view of a deformed double row staple for use in a stapler in accordance with the present invention.
La Figura 55 es una vista lateral de una grapa de doble hilera deformada para uso en una grapadora según la presente invención.Figure 55 is a side view of a deformed double row staple for use in a stapler in accordance with the present invention.
La Figura 56 es una vista de extremo de una grapa de doble hilera deformada para uso en una grapadora según la presente invención.Figure 56 is an end view of a deformed double row staple for use in a stapler in accordance with the present invention.
La Figura 57 es una vista transversal, parcialmente transparente de un efector terminal para uso en una grapadora según la presente invención.Figure 57 is a partially transparent cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 58 es una vista transversal, parcialmente transparente de un efector terminal para uso en una grapadora según la presente invención.Figure 58 is a partially transparent cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 59 es una vista transversal, parcialmente transparente de un efector terminal para uso en una grapadora según la presente invención.Figure 59 is a partially transparent cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 60 es una vista en perspectiva superior, de sección, parcialmente transparente de un efector terminal para uso en una grapadora según la presente invención.Figure 60 is a partially transparent sectional top perspective view of an end effector for use in a stapler in accordance with the present invention.
La Figura 61 es una vista de sección lateral, parcialmente transparente de un efector terminal para uso en una grapadora según la presente invención.Figure 61 is a partially transparent, side sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 62 es una vista de sección superior de un efector terminal para uso en una grapadora según la presente invención.Figure 62 is a top sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 63 es una vista en perspectiva superior, semitransparente de un efector terminal para uso en una grapadora según la presente invención.Figure 63 is a semi-transparent, top perspective view of an end effector for use in a stapler in accordance with the present invention.
La Figura 64 es una vista transversal de un efector terminal para uso en una grapadora según la presente invención.Figure 64 is a cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 65 es una vista transversal de un efector terminal para uso en una grapadora según la presente invención.Figure 65 is a cross-sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 66A es una vista de extremo transversal de un efector terminal para uso en una grapadora según la presente invención.Figure 66A is a cross-sectional end view of an end effector for use in a stapler in accordance with the present invention.
La Figura 66B es una vista de extremo transversal de una viga en I para uso en una grapadora según la presente invención.Figure 66B is a cross-sectional end view of an I-beam for use in a stapler in accordance with the present invention.
La Figura 66C es una vista de extremo transversal de una viga en I para uso en una grapadora según la presente invención.Figure 66C is a cross-sectional end view of an I-beam for use in a stapler in accordance with the present invention.
La Figura 66D es una vista de extremo transversal de una viga en I para uso en una grapadora según la presente invención.Figure 66D is a cross-sectional end view of an I-beam for use in a stapler in accordance with the present invention.
La Figura 67 es una vista de sección superior de un efector de extremo para uso en una grapadora según la presente invención.Figure 67 is a top sectional view of an end effector for use in a stapler according to present invention.
La Figura 68 es una vista de extremo transversal de un efector terminal para uso en una grapadora según la presente invención.Figure 68 is a cross-sectional end view of an end effector for use in a stapler in accordance with the present invention.
La Figura 69 es una vista inferior de sección de un efector terminal para uso en una grapadora según la presente invención.Figure 69 is a bottom sectional view of an end effector for use in a stapler in accordance with the present invention.
La Figura 70 es una vista en perspectiva superior de un pulsador interno para uso en una grapadora según la presente invención.Figure 70 is a top perspective view of an internal push button for use in a stapler in accordance with the present invention.
La Figura 71 es una vista en perspectiva superior de un pulsador interno para uso en una grapadora según la presente invención.Figure 71 is a top perspective view of an internal push button for use in a stapler in accordance with the present invention.
La Figura 72 es una vista en perspectiva superior de un pulsador externo y grapa para uso en una grapadora según la presente invención.Figure 72 is a top perspective view of an external pusher and staple for use in a stapler in accordance with the present invention.
La Figura 73 es una vista en perspectiva superior, de sección parcial de un efector terminal que muestra un deslizador de viga en I, dos pulsadores internos, dos pulsadores externos y cuatro grapas para uso en una grapadora según la presente invención.Figure 73 is a partially sectional, top perspective view of an end effector showing an I-beam slider, two internal pushbuttons, two external pushbuttons, and four staples for use in a stapler in accordance with the present invention.
La Figura 74 es una vista en perspectiva superior, de sección parcial de un efector terminal que muestra un deslizador de viga en I, un pulsador interno, un pulsador externo y dos grapas para uso en una grapadora según la presente invención.Figure 74 is a partially sectional, top perspective view of an end effector showing an I-beam slider, an internal pusher, an external pusher, and two staples for use in a stapler in accordance with the present invention.
La Figura 75 es una vista en perspectiva superior, de sección parcial de un efector terminal que muestra un deslizador de viga en I, dos pulsadores internos, dos pulsadores externos y cuatro grapas para uso en una grapadora según la presente invención.Figure 75 is a partially sectional, top perspective view of an end effector showing an I-beam slider, two internal pushbuttons, two external pushbuttons, and four staples for use in a stapler in accordance with the present invention.
La Figura 76 es una vista en elevación lateral, de sección parcial de un efector terminal que muestra un deslizador de viga en I, dos pulsadores internos, un pulsador externo y tres grapas para uso en una grapadora según la presente invención.Figure 76 is a partially sectional, side elevation view of an end effector showing an I-beam slider, two internal pushbuttons, one external pushbutton, and three staples for use in a stapler in accordance with the present invention.
La Figura 77 es una vista inferior, de sección parcial de un efector terminal que muestra un deslizador de viga en I, dos pulsadores internos, dos pulsadores externos y cuatro grapas para uso en una grapadora según la presente invención.Figure 77 is a bottom, partially sectional view of an end effector showing an I-beam slider, two internal pushbuttons, two external pushbuttons, and four staples for use in a stapler in accordance with the present invention.
La Figura 78 es una vista en elevación frontal de una grapa para uso en una grapadora según la presente invención.Figure 78 is a front elevation view of a staple for use in a stapler in accordance with the present invention.
La Figura 79 es una vista en elevación lateral de una grapa para uso en una grapadora según la presente invención. La Figura 80 es una vista en perspectiva superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 79 is a side elevation view of a staple for use in a stapler in accordance with the present invention. Figure 80 is a top perspective view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 81 es una vista en perspectiva superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 81 is a top perspective view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 82 es una vista en elevación frontal de una grapa deformada para uso en una grapadora según la presente invención.Figure 82 is a front elevation view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 83 es una vista superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 83 is a top view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 84 es una vista en elevación lateral de una grapa deformada para uso en una grapadora según la presente invención.Figure 84 is a side elevation view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 85 es una vista en perspectiva superior de una grapa para uso en una grapadora según la presente invención.Figure 85 is a top perspective view of a staple for use in a stapler in accordance with the present invention.
La Figura 86 es una vista en perspectiva superior de una grapa para uso en una grapadora según la presente invención.Figure 86 is a top perspective view of a staple for use in a stapler in accordance with the present invention.
La Figura 87 es una vista en elevación frontal de una grapa para uso en una grapadora según la presente invención.Figure 87 is a front elevation view of a staple for use in a stapler in accordance with the present invention.
La Figura 88 es una vista superior de una grapa para uso en una grapadora según la presente invención.Figure 88 is a top view of a staple for use in a stapler in accordance with the present invention.
La Figura 89 es una vista lateral de una grapa para uso en una grapadora según la presente invención. Figure 89 is a side view of a staple for use in a stapler in accordance with the present invention.
La Figura 90 es una vista en perspectiva superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 90 is a top perspective view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 91 es una vista superior de una grapa deformada para uso en una grapadora según la presente invención.Figure 91 is a top view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 92 es una vista en elevación lateral de una grapa deformada para uso en una grapadora según la presente invención.Figure 92 is a side elevation view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 93 es una vista en elevación frontal de una grapa deformada para uso en una grapadora según la presente invención.Figure 93 is a front elevation view of a deformed staple for use in a stapler in accordance with the present invention.
La Figura 94 es un esquema de una vista transversal de una mandíbula inferior y grapa.Figure 94 is a schematic of a cross-sectional view of a lower jaw and staple.
La Figura 95 es un esquema de una vista transversal de una mandíbula inferior y grapa para uso en una grapadora según la presente invención.Figure 95 is a schematic of a cross-sectional view of a lower jaw and staple for use in a stapler in accordance with the present invention.
La Figura 96 es un esquema de una vista transversal de una mandíbula inferior y grapa para uso en una grapadora según la presente invención.Figure 96 is a schematic of a cross-sectional view of a lower jaw and staple for use in a stapler in accordance with the present invention.
Descripción detallada de la InvenciónDetailed description of the invention
Con respecto a la Figura 3, se muestra una vista en perspectiva de una grapadora quirúrgica 10 según la presente invención. La grapadora 10 está compuesta por un ensamblaje de mango 12 conectado de forma extraíble a un ensamblaje de cartucho de grapadora 14. El ensamblaje de mango 12 está configurado para controlar el instrumento y accionar el despliegue de grapas ubicadas en el extremo distal del ensamblaje de cartucho de grapadora 14. Luego de que se han gastado las grapas desde la grapadora 10, el ensamblaje de cartucho de grapadora 14 se remueve del ensamblaje de mango 12 y se conecta un nuevo ensamblaje de cartucho 14 de la grapadora al ensamblaje de mango 12 para un grapado continuo. En una variación alternativa, se puede reemplazar un cartucho de grapas independiente desde el extremo distal del ensamblaje de cartucho de grapadora 14 para un grapado continuo.With reference to Figure 3, a perspective view of a surgical stapler 10 according to the present invention is shown. Stapler 10 is comprised of a handle assembly 12 removably connected to a stapler cartridge assembly 14. Handle assembly 12 is configured to control the instrument and actuate the deployment of staples located at the distal end of the cartridge assembly. Stapler 14. After the staples have been used from the stapler 10, the stapler cartridge assembly 14 is removed from the handle assembly 12 and a new stapler cartridge assembly 14 is connected to the handle assembly 12 for a continuous stapling. In an alternative variation, a separate staple cartridge can be replaced from the distal end of the stapler cartridge assembly 14 for continuous stapling.
Con respecto a la Figura 4, el ensamblaje de cartucho de grapadora 14 se analizará a continuación en detalle. El ensamblaje de cartucho de grapadora 14 incluye un conector 16 en el extremo proximal y un efector terminal 18 en el extremo distal. Un tubo externo 20 se conecta al efector terminal 18 en el extremo distal y al conector 16 en el extremo proximal. Un eje accionador 22 se dispone dentro del lumen del tubo externo 20. El tubo externo 20 es sustancialmente cilíndrico con un diámetro externo de aproximadamente 5-10 mm. El eje accionador 22 está configurado para deslizarse longitudinalmente respecto al tubo externo 20. El detalle del extremo proximal del ensamblaje de cartucho de grapadora 14 se muestra en la Figura 5.With reference to Figure 4, the stapler cartridge assembly 14 will now be discussed in detail. The stapler cartridge assembly 14 includes a connector 16 at the proximal end and an end effector 18 at the distal end. An outer tube 20 connects to end effector 18 at the distal end and to connector 16 at the proximal end. A drive shaft 22 is disposed within the lumen of outer tube 20. The outer tube 20 is substantially cylindrical with an outer diameter of approximately 5-10mm. The actuator shaft 22 is configured to slide longitudinally relative to the outer tube 20. The detail of the proximal end of the stapler cartridge assembly 14 is shown in Figure 5.
Con respecto a la Figura 5, se muestra el extremo proximal del ensamblaje de cartucho de grapadora 14. El conector 16 incluye un tornillo 24 que se extiende lateralmente hacia afuera desde la superficie externa del conector 16. Un tornillo 24 similar se extiende en el lado opuesto del conector 16 y no es visible en la Figura 5. El tornillo 24 está configurado para una conexión tipo bayoneta con el ensamblaje de mango 12 de la grapadora 10 que incluye una ranura complementaria para recibir el tornillo 24 para asegurar el ensamblaje de cartucho 14 al ensamblaje de mango 12. La Figura 5 también ilustra al eje accionador 22 desplazado proximalmente respecto al tubo externo 20 cuando se compara con la Figura 4 en la que el eje accionador 22 se muestra desplazado más distalmente respecto al tubo externo 20. Tal como se observa en la Figura 5, el extremo proximal del eje accionador 22 incluye un tornillo 26 que se extiende lateralmente hacia afuera desde el eje accionador 22. El tornillo 26 está configurado para una conexión tipo bayoneta con un eje accionador del ensamblaje de mango 12 que incluye una ranura complementaria para recibir el tornillo 26. Acoplar el tornillo 24 del conector 16 al ensamblaje de mango 12 simultáneamente acopla el tornillo 26 del eje accionador 22 al eje accionador del ensamblaje de mango 12. Cuando se conecta al ensamblaje de mango 12, el ensamblaje de mango 12 se usa para mover el eje accionador 22 hacia adelante y hacia atrás dentro del tubo externo 20 para lograr la abertura y cierre de los miembros tipo mandíbula distales y el despliegue de grapas.Referring to Figure 5, the proximal end of staple cartridge assembly 14 is shown. Connector 16 includes a screw 24 that extends laterally outward from the outer surface of connector 16. A similar screw 24 extends on the side. opposite of connector 16 and is not visible in Figure 5. Screw 24 is configured for a bayonet connection with handle assembly 12 of stapler 10 that includes a complementary slot to receive screw 24 to secure cartridge assembly 14 to handle assembly 12. Figure 5 also illustrates actuator shaft 22 displaced proximally relative to outer tube 20 when compared to Figure 4 in which actuator shaft 22 is shown offset more distally relative to outer tube 20. As shown seen in Figure 5, the proximal end of actuator shaft 22 includes a screw 26 that extends laterally outward from actuator shaft 22. Screw 26 and It is configured for a bayonet connection to a drive shaft of handle assembly 12 that includes a complementary slot to receive screw 26. Engaging screw 24 of connector 16 to handle assembly 12 simultaneously engages screw 26 of drive shaft 22 to the shaft. handle assembly actuator 12. When connected to handle assembly 12, handle assembly 12 is used to move actuator shaft 22 back and forth within outer tube 20 to achieve opening and closing of the jaw-like members distal and staple deployment.
Con respecto a la Figura 6, el eje accionador 22 se describirá a continuación. El eje accionador 22 es un eje alargado con una parte 28 proximal sustancialmente cilíndrica con tornillos accionadores 26 en el extremo proximal para la conexión con el accionador del ensamblaje de mango 12. La parte 28 sustancialmente cilíndrica tiene un tamaño para un encaje perfecto concéntrico dentro del lumen del tubo externo 20. La parte 28 cilíndrica está conectada con clavijas a una parte de la viga en I extendida 30 hacia el extremo distal del eje accionador 22. El extremo distal del eje accionador 22 incluye una viga en I 32 conectada a la parte de la viga en I extendida 30. With respect to Figure 6, the drive shaft 22 will be described below. The actuator shaft 22 is an elongated shaft with a substantially cylindrical proximal portion 28 with actuating screws 26 at the proximal end for connection to the actuator of the handle assembly 12. The substantially cylindrical portion 28 is sized for a concentric snug fit within the lumen of the outer tube 20. The cylindrical portion 28 is dowel-connected to a portion of the I-beam 30 extending toward the distal end of the actuator shaft 22. The distal end of the actuator shaft 22 includes an I-beam 32 connected to the of the extended I-beam 30.
Con respecto a las Figuras 7-12, la viga en I 32 se describirá a continuación. La viga en I 32 incluye una parte superior 34 y una parte inferior 36 interconectadas por una parte media 38. La parte superior 34 incluye un extremo frontal biselado 40 y una parte superior curva. La parte media 38 incluye una cuchilla 42 que incluiría un borde principal afilado que se muestra como una superficie roma en las Figuras 7-12. En el extremo posterior, la parte media 38 incluye una parte 46 para conectarse con la parte de la viga en I extendida 30 como se muestra en la Figura 6. La parte inferior 36 encabeza el extremo frontal de la viga en I 32 e incluye una parte inferior curva con una superficie externa convexa y una superficie principal 44 que se asemeja a una quitanieves. La superficie principal 44 incluye dos superficies convergentes que se encuentran en una línea o punta vertical. Cada superficie convergente se extiende hacia afuera desde la punta en espiral helicoidal, es decir, no solo se extiende hacia arriba sino que da vueltas en espiral o se curva o rota con respecto al eje longitudinal de la viga en I 32 para crear el diseño de cuña en hélice. La vista en elevación frontal de la viga en I se muestra en la Figura 11 que ilustra el perfil que tiene sustancialmente forma de una letra mayúscula "I" con una parte curva inferior. La viga en I se desliza longitudinalmente dentro del efector terminal 18 y como tal puede denominarse un deslizador. La viga en I/deslizador 32 está configurada para impulsar a las grapas fuera del efector terminal 18 a través de la superficie principal 44. With reference to Figures 7-12, the I-beam 32 will be described below. I-beam 32 includes a top 34 and a bottom 36 interconnected by a middle portion 38. The top 34 includes a beveled front end 40 and a curved top. The middle portion 38 includes a blade 42 that would include a sharp leading edge that is shown as a blunt surface in Figures 7-12. At the rear end, the middle portion 38 includes a portion 46 for connecting to the extended I-beam portion 30 as shown in Figure 6. The bottom portion 36 tops the front end of the I-beam 32 and includes a curved bottom with a convex outer surface and a main surface 44 that resembles a snowplow. The main surface 44 includes two converging surfaces that meet on a vertical line or point. Each converging surface extends outward from the helical spiral tip, that is, it not only extends upward but spirals or curves or rotates with respect to the longitudinal axis of the I-beam 32 to create the design of helix wedge. The front elevation view of the I-beam is shown in Figure 11 illustrating the profile that is substantially in the shape of a capital letter "I" with a lower curved portion. The I-beam slides longitudinally within end effector 18 and as such may be referred to as a slider. I-beam / slider 32 is configured to drive staples out of end effector 18 through major surface 44.
Con respecto a las Figuras 13-16, se describirá el efector terminal 18. El efector terminal 18 incluye una mandíbula superior 48 abisagrada a una mandíbula inferior 50. Cuando las mandíbulas 48, 50 están en una orientación cerrada forman una sección transversal sustancialmente circular cuando se observa desde el extremo. La mandíbula inferior 50 incluye un alojamiento de grapas o cartucho de grapas 52 que contiene múltiples grapas 54. La mandíbula inferior 50 comprende un armazón semicilíndrico hueco o mandíbula inferior externa 51 y una mandíbula inferior interna con forma acorde o cartucho 52 dispuesto dentro de la mandíbula inferior externa 51. La mandíbula inferior interna 52 puede o no removerse y reemplazarse como un cartucho para introducir más grapas 54 para un disparo continuo. En una variación en la que la mandíbula inferior interna 52 esté fija, la grapadora 10 en su totalidad es descartable luego de un único disparo o, de manera alternativa, el ensamblaje de cartucho de grapadora 14 funciona como un cartucho descartable y se remueve y reemplaza para un disparo continuo. La mandíbula inferior interna 52 incluye múltiples canales 53 o trayectorias de grapas configurados para recibir grapas 54 y funcionan como una guía para suministrar las grapas 54 hacia la mandíbula superior 48. Cada canal 53 forma una abertura superior en la superficie superior de la mandíbula inferior 50 a través de la cual una grapa 54 sale de la mandíbula inferior 50. La mandíbula inferior interna 52 incluye un canal central 55 que se extiende longitudinalmente y está configurado para recibir una viga en I 32 que se traslada longitudinalmente. La parte inferior de la mandíbula inferior interna 52 está separada de la mandíbula inferior externa 51 para formar un hueco con forma acorde para recibir la parte inferior 36 de viga en I 32 a medida que se traslada longitudinalmente. Cada canal 53 se extiende entre la abertura superior y una abertura inferior. La abertura inferior está en comunicación con el hueco entre la mandíbula inferior interna y externa. Cada canal 53 es curvo y transcribe un arco entre la abertura superior del canal y la abertura inferior del canal como se muestra en la Figura 16. En una sección transversal tomada perpendicular al eje longitudinal del efector terminal 18, el canal 53 tiene un radio de curvatura que sustancialmente se corresponde con el radio de curvatura de la mandíbula inferior externa 51 y forma una trayectoria de suministro circunferencial para la grapa. En una variación, los canales 53 son concéntricos alrededor del punto central de una sección transversal tomada perpendicular al eje longitudinal de las mandíbulas cerradas 48, 50. Una grapa 54 de cuatro hileras se muestra residente en el canal 53 en la Figura 13. Un pulsador 58 también se dispone dentro de cada canal 53. Dos pulsadores 58 son ligeramente visibles en la Figura 16. El pulsador 58 está configurado para hacer contacto con la superficie principal 44 del deslizador de viga en I 32 y, a su vez, hacer contacto con al menos una grapa 54.With reference to Figures 13-16, end effector 18 will be described. End effector 18 includes an upper jaw 48 hinged to a lower jaw 50. When the jaws 48, 50 are in a closed orientation they form a substantially circular cross section when it is observed from the extreme. The lower jaw 50 includes a staple housing or staple cartridge 52 containing multiple staples 54. The lower jaw 50 comprises a hollow semi-cylindrical frame or outer lower jaw 51 and a chord-shaped inner lower jaw or cartridge 52 disposed within the jaw. lower outer 51. Lower inner jaw 52 may or may not be removed and replaced as a cartridge to insert more staples 54 for continuous firing. In a variation where the inner lower jaw 52 is fixed, the entire stapler 10 is disposable after a single shot or, alternatively, the stapler cartridge assembly 14 functions as a disposable cartridge and is removed and replaced. for continuous shooting. The inner lower jaw 52 includes multiple channels 53 or staple paths configured to receive staples 54 and function as a guide to supply the staples 54 toward the upper jaw 48. Each channel 53 forms an upper opening in the upper surface of the lower jaw 50. through which a staple 54 exits the lower jaw 50. The lower inner jaw 52 includes a central channel 55 that extends longitudinally and is configured to receive an I-beam 32 that translates longitudinally. The lower inner lower jaw portion 52 is spaced from the outer lower jaw 51 to form a chord-shaped recess to receive the lower I-beam portion 36 32 as it is longitudinally translated. Each channel 53 extends between the upper opening and a lower opening. The lower opening is in communication with the gap between the inner and outer lower jaw. Each channel 53 is curved and transcribes an arc between the upper channel opening and the lower channel opening as shown in Figure 16. In a cross section taken perpendicular to the longitudinal axis of end effector 18, channel 53 has a radius of curvature that substantially corresponds to the radius of curvature of the lower outer jaw 51 and forms a circumferential supply path for the staple. In a variation, channels 53 are concentric around the center point of a cross section taken perpendicular to the longitudinal axis of closed jaws 48, 50. A four-row staple 54 is shown resident in channel 53 in Figure 13. A push button 58 is also disposed within each channel 53. Two pushbuttons 58 are faintly visible in Figure 16. Pushbutton 58 is configured to contact major surface 44 of I-beam slider 32 and, in turn, make contact with at least one staple 54.
Con respecto a las Figuras 17-23, se muestra un pulsador 58 según la presente invención. El pulsador 58 es un objeto con forma de cuña configurado para interconectarse entre el deslizador de viga en I 32 y una o más grapas 54. El pulsador 58 incluye una superficie superior 60 y una superficie inferior 62 interconectadas por dos superficies laterales 64, 66 y dos superficies de extremo 68, 70. La superficie inferior 62 incluye un deslizador de viga en I que hace contacto con la superficie 72 configurada para hacer contacto con la superficie principal 44 del deslizador de viga en I 32. El deslizador de viga en I que hace contacto con la superficie 72 se moldea para ajustarse a la superficie principal 44. Si la superficie principal 44 del deslizador de viga en I 32 tiene forma helicoidal como se describió anteriormente, entonces la superficie de contacto 72 es también helicoidal. La superficie superior 60 está configurada para hacer contacto con una o más grapas 54 y como tal comprende una superficie de contacto de grapas. La superficie superior 60 y la superficie inferior 62 que incluye la superficie de contacto 72 están levemente inclinadas con respecto a la superficie lateral 66 y convergen ligeramente hacia la superficie lateral 64. Tal como se puede ver en la Figura 21, la superficie lateral 64 es ligeramente cóncava y la superficie lateral opuesta 66 es ligeramente convexa. Ambas superficies laterales 64, 66 son concéntricas entre sí. En una variación, las superficies laterales 64, 66 son concéntricas con respecto al punto central de una sección transversal tomada perpendicular al eje longitudinal de las mandíbulas 48, 50 estando las mandíbulas 48, 50 en una configuración cerrada. En una variación, las superficies laterales 64, 66 tienen una curvatura que sustancialmente coincide con la curvatura del canal 53 en el que este reside. En una variación, el canal 53 es circunferencial respecto a una sección transversal perpendicular al eje longitudinal de las mandíbulas 48, 50 estando las mandíbulas 48, 50 en una configuración cerrada y las superficies laterales 64, 66 del pulsador sustancialmente coinciden con la curvatura circunferencial. Las superficies de extremo 68 y 70 son sustancialmente paralelas y perpendiculares. Cuando es impulsado por el deslizador de viga en I 32, cada pulsador 58 hace contacto con una grapa 54 y se desplaza de forma uniforme dentro de su canal 53 respectivo.With reference to Figures 17-23, a pushbutton 58 is shown in accordance with the present invention. Pushbutton 58 is a wedge-shaped object configured to interconnect between I-beam slider 32 and one or more clips 54. Pushbutton 58 includes a top surface 60 and a bottom surface 62 interconnected by two side surfaces 64, 66 and two end surfaces 68, 70. The bottom surface 62 includes an I-beam slider that contacts surface 72 configured to contact the main surface 44 of the I-beam slider 32. The I-beam slider that makes contact with surface 72 and is molded to fit major surface 44. If major surface 44 of I-beam slider 32 is helical in shape as described above, then contact surface 72 is helical as well. Top surface 60 is configured to contact one or more staples 54 and as such comprises a staple contact surface. The upper surface 60 and the lower surface 62 including the contact surface 72 are slightly inclined with respect to the lateral surface 66 and converge slightly towards the lateral surface 64. As can be seen in Figure 21, the lateral surface 64 is slightly concave and the opposite side surface 66 is slightly convex. Both side surfaces 64, 66 are concentric with each other. In a variation, the side surfaces 64, 66 are concentric with respect to the center point of a cross section taken perpendicular to the longitudinal axis of the jaws 48, 50 with the jaws 48, 50 in a closed configuration. In a variation, the side surfaces 64, 66 have a curvature that substantially matches the curvature of the channel 53 in which it resides. In a variation, the channel 53 is circumferential with respect to a cross section perpendicular to the longitudinal axis of the jaws 48, 50 with the jaws 48, 50 being in a closed configuration and the side surfaces 64, 66 of the push button substantially coinciding with the circumferential curvature. End surfaces 68 and 70 are substantially parallel and perpendicular. When driven by I-beam slider 32, each pusher 58 contacts a staple 54 and travels uniformly within its respective channel 53.
Con respecto a las Figuras 13-16, la mandíbula superior 48 se describirá a continuación. La mandíbula superior 48 tiene forma sustancialmente semicilíndrica para ajustarse a un lumen cilíndrico de una cánula en la que se inserta. La mandíbula superior 48 incluye una ranura central 76 que se extiende longitudinalmente. La ranura central 76 tiene forma acorde y está configurada para recibir la parte superior 34 de la viga en I 32 y al menos una parte de la parte media 38 más angosta de la viga en I 32 de forma tal que la viga en I 32 es capaz de un movimiento longitudinal respecto a la mandíbula superior 48 dentro y a lo largo de la ranura central 76. La ranura central 76 incluye un extremo proximal abierto que está inclinado y se configura para leva contra el extremo frontal biselado 40 de la viga en I 32. La mandíbula superior 48 está sesgada por resorte en una orientación abierta con respecto a la mandíbula inferior 50 y a medida que el extremo frontal biselado 40 de la viga en I 32 entra en la ranura central 76 y, en particular, la parte superior 34 entra en el extremo superior más ancho de la ranura central 76, las mandíbulas superior e inferior 48, 50 son forzadas a cerrarse.With respect to Figures 13-16, the upper jaw 48 will be described below. The upper jaw 48 is substantially semi-cylindrical in shape to fit a cylindrical lumen of a cannula into which it is inserted. Upper jaw 48 includes a longitudinally extending central slot 76. The central groove 76 is chord-shaped and configured to receive the upper portion 34 of the I-beam 32 and at least a portion of the narrower middle portion 38 of the I-beam 32 such that the I-beam 32 is capable of longitudinal movement relative to the upper jaw 48 in and along the central slot 76. The central slot 76 includes an open proximal end that is inclined and is configured to cam against the beveled front end 40 of the beam at I 32. The upper jaw 48 is spring biased in an open orientation with respect to the lower jaw 50 and as the beveled front end 40 of the I-beam 32 enters the central slot 76 and, in particular, the upper 34 enters the wider upper end of central slot 76, upper and lower jaws 48, 50 are forced to close.
El movimiento hacia adelante y atrás de la viga en I 32 hacia adentro y hacia afuera de la ranura central 76 o contra la abertura proximal de la ranura central 76, abre y cierra el efector terminal 18 lo que le permite al usuario retener y liberar tejido y la reposición de la grapadora 10. Al estar el efector terminal 18 en la configuración cerrada, la viga en I 32 es capaz de un traslado longitudinal adicional dentro de la ranura central 76. Luego de la eyección de las grapas 54, la viga en I 32 se retracta proximalmente a través del ensamblaje de mango 12 y a medida que la viga en I 32 sale de la ranura central 76, la mandíbula superior 48 sesgada por resorte se mueve en una orientación abierta. Luego de la eyección de las grapas 54 y la retracción de la viga en I 32, se evita el traslado hacia adelante repetida de la viga en I T 32 dentro de la ranura central 76 mediante un mecanismo de bloqueo para evitar el uso accidental de un cartucho ya disparado.The back and forth movement of the I-beam 32 in and out of the central slot 76 or against the proximal opening of the central slot 76 opens and closes the end effector 18 allowing the user to retain and release tissue. and repositioning of stapler 10. With end effector 18 in the closed configuration, I-beam 32 is capable of further longitudinal translation within central slot 76. Following ejection of staples 54, the beam in I 32 retracts proximally through handle assembly 12 and as I beam 32 exits central slot 76, spring biased upper jaw 48 moves in an open orientation. Following ejection of staples 54 and retraction of I-beam 32, repeated forward movement of IT-beam 32 into central slot 76 is prevented by a locking mechanism to prevent accidental use of a cartridge. already fired.
Además, con respecto a las Figuras 44-46, la mandíbula 48 incluye además una superficie de yunque interna 74 o placa que mira hacia la mandíbula inferior 50 y se separa de esta cuando está en la posición cerrada. La superficie de yunque 74 está configurada para recibir las patas de una grapa 54 y guiar, desviar, inclinar, doblar, ondular o cerrar las patas de la grapa a medida que la grapa es impulsada a través de tejido contra la superficie de yunque 74. Para facilitar la formación de grapas 54 para asegurar tejido, se incluyen múltiples compartimientos formadores de grapas como se muestra en las Figuras 44-46 en la superficie de yunque 74. Estas formaciones de superficie de un yunque típico ayudan a la deformación de la grapa a medida que se despliega para lograr un cierre de grapa adecuado. Los compartimientos formadores de grapas se alinean con las aberturas de salida de los canales 53 en la mandíbula inferior 50. Cualquier desalineación entre los compartimientos formadores de grapas y la grapa de eyección conduce a que las grapas no encuentren los compartimientos formadores de grapas y puede resultar en una falla catastrófica de la línea de grapas. Los compartimientos formadores de grapas generalmente incluyen dos copas formadoras de patas de grapa adyacentes con una superficie de canalización curva o inclinada formada alrededor del perímetro de cada una de las copas formadoras de grapas. Las dos copas formadoras de patas de grapa adyacentes crean una forma de hueso de perro que facilita la formación de grapas con forma de B consistentes generalmente a partir de grapas no deformadas con forma de U en ángulo recto. Si se despliegan grapas de cuatro hileras, entonces la superficie de yunque 74 incluye cuatro copas formadoras de grapas adyacentes alineadas con las patas de grapas de eyección. Los compartimientos formadores de grapas independientes se proporcionan en cada ubicación formadora de grapas opuesta a los canales 53 de cartucho de la mandíbula inferior 50.In addition, with respect to Figures 44-46, the jaw 48 further includes an internal anvil surface 74 or plate that faces toward and separates from the lower jaw 50 when in the closed position. Anvil surface 74 is configured to receive the legs of a staple 54 and guide, deflect, skew, bend, crimp, or close the legs of the staple as the staple is driven through tissue against the anvil surface 74. To facilitate the formation of staples 54 to secure tissue, multiple staple-forming compartments as shown in Figures 44-46 are included in the anvil surface 74. These surface formations of a typical anvil aid in deformation of the staple to as it unfolds to achieve a proper staple closure. The staple-forming compartments align with the outlet openings of the channels 53 in the lower jaw 50. Any misalignment between the staple-forming compartments and the ejection staple leads to the staples not finding the staple-forming compartments and can result in a catastrophic failure of the staple line. Staple-forming compartments generally include two adjacent staple-leg-forming cups with a curved or sloped channel surface formed around the perimeter of each of the staple-forming cups. The two adjacent staple leg-forming cups create a dog bone shape that facilitates the formation of consistent B-shaped staples generally from right-angle U-shaped undeformed staples. If four-row staples are deployed, then the anvil surface 74 includes four adjacent staple-forming cups aligned with the ejector staple legs. Separate staple-forming compartments are provided at each staple-forming location opposite the cartridge channels 53 of the lower jaw 50.
Con respecto a continuación a las Figuras 24-27, se describirá una grapa 54 según la presente invención. La grapa 54 es una grapa 54 de cuatro hileras que se muestra en su condición no deformada o abierta. La grapa 54 de cuatro hileras incluye dos primeras patas más largas 78A, 78B y dos segundas patas más cortas 80A, 80B interconectadas por una base 82. Las dos primeras patas más largas 78A, 78B están escalonadas con respecto a las dos segundas patas más cortas 80A, 80B de forma tal que cuando se deforman o cierran contra la superficie de yunque 74, las primeras patas 78A, 78B no hacen contacto con las segundas patas adyacentes 80A, 80B. La base 82 funciona como una superficie de leva para el acoplamiento con un pulsador 58. La patas más largas y más cortas 78A, 78B, 80A, 80B se extienden todas hacia arriba desde la base 82 y se curvan hacia un lado. En una variación, las patas más largas 78A, 78B son concéntricas con las patas más cortas 80A, 80B. En una variación, las patas 78A, 78B, 80A, 80B son concéntricas con respecto al punto central de una sección transversal tomada perpendicular al eje longitudinal de las mandíbulas 48, 50 con las mandíbulas 48, 50 en una configuración cerrada. En una variación, las patas 78A, 78B, 80A, 80B tienen una curvatura que sustancialmente coincide con la curvatura del canal 53 en el que la grapa 54 reside. Tal como se observa en la Figura 26, las patas 78A, 78B, 80A, 80B se curvan hacia la derecha con cada pata que tiene una superficie cóncava y una superficie convexa interconectadas mediante dos superficies laterales. Cada pata 78A, 78B, 80A, 80B se inclina en la misma dirección con respecto a la base 82. Cada pata interseca con la base 82, en el punto de intersección, una muesca 84 se forma en la base 82 en uno o más lados de cada pata para fines de fabricación. Las dos superficies laterales de cada pata convergen para formar una punta afilada en una intersección de línea en el extremo distal libre de la pata. Cada una de las patas 78A, 78B, 80A, 80B tiene su respectiva punta 86A, 86B, 88A, 88B. La punta comienza donde las superficies laterales comienzan a estrecharse o disminuir en un área transversal en la dirección distalmente a lo largo de la pata. Las puntas 86A, 86B, 88A, 88B pueden formarse de cualquier manera y pueden tener cualquier otra forma geométrica que sea adecuada para perforar y penetrar tejido a través del cual se suministra la grapa.With reference now to Figures 24-27, a staple 54 according to the present invention will be described. Staple 54 is a four row staple 54 shown in its undeformed or open condition. The four-row staple 54 includes two longer first legs 78A, 78B and two shorter second legs 80A, 80B interconnected by a base 82. The two longest first legs 78A, 78B are staggered with respect to the two shorter second legs 80A, 80B such that when deformed or closed against anvil surface 74, first legs 78A, 78B do not contact adjacent second legs 80A, 80B. Base 82 functions as a cam surface for engagement with a push button 58. Longer and shorter legs 78A, 78B, 80A, 80B all extend upward from base 82 and curve to one side. In a variation, the longer legs 78A, 78B are concentric with the shorter legs 80A, 80B. In a variation, the legs 78A, 78B, 80A, 80B are concentric with respect to the center point of a cross section taken perpendicular to the longitudinal axis of the jaws 48, 50 with the jaws 48, 50 in a closed configuration. In a variation, the legs 78A, 78B, 80A, 80B have a curvature that substantially matches the curvature of the channel 53 in which the staple 54 resides. As seen in Figure 26, legs 78A, 78B, 80A, 80B curve to the right with each leg having a concave surface and a convex surface interconnected by two side surfaces. Each leg 78A, 78B, 80A, 80B is inclined in the same direction with respect to base 82. Each leg intersects base 82, at the point of intersection, a notch 84 is formed in base 82 on one or more sides. of each leg for manufacturing purposes. The two side surfaces of each leg converge to form a sharp point at a line intersection at the free distal end of the leg. Each of the legs 78A, 78B, 80A, 80B has its respective tip 86A, 86B, 88A, 88B. The tip begins where the lateral surfaces begin to taper or taper in a transverse area in the direction distally along the leg. Tips 86A, 86B, 88A, 88B can be formed in any way and can have any other geometric shape that is suitable for piercing and penetrating tissue through which the staple is delivered.
Con respecto aún a las Figuras 24-27, las primeras patas más largas 78A, 78B miden aproximadamente 0,246 cm (0,097 pulgadas) y las segundas patas más cortas 80A, 80B tienen una longitud de aproximadamente 0,127 cm (0,050 pulgadas) con un ángulo central con respecto a la base de aproximadamente 60 grados. La relación de las segundas patas más cortas 80A, 80B respecto a las primeras patas más largas 78A, 78B es de aproximadamente 1/2. La longitud total de la base 82 es de aproximadamente 0,254 cm (0,100 pulgadas) y en una variación cada pata 78A, 78B, 80A, 80B es concéntrica alrededor del punto central de una sección transversal tomada perpendicular al eje longitudinal de las mandíbulas 48, 50 en una orientación cerrada. El radio de curvatura de la superficie externa de las primeras patas más largas 78A, 78B es de aproximadamente 0,292 cm (0,115 pulgadas). El radio de curvatura de la superficie externa en las intersecciones con la base 82 es de aproximadamente 0,023 cm (0,009 pulgadas). El radio de curvatura de la superficie interna de las segundas patas más cortas 80A, 80B es de aproximadamente 0,165 cm (0,065 pulgadas). La distancia entre las superficies laterales o grosor de las patas es de aproximadamente 0,025 cm (0,010 pulgadas). La distancia entre la superficie interna y la superficie externa o ancho de las patas es de aproximadamente 0,038 cm (0,015 pulgadas).Still referring to Figures 24-27, the first longer legs 78A, 78B are approximately 0.246 cm (0.097 inches) and the second shorter legs 80A, 80B are approximately 0.127 cm (0.050 inches) long with a central angle. relative to the base about 60 degrees. The ratio of the second shorter legs 80A, 80B to the first longer legs 78A, 78B is about 1/2. The total length of the base 82 is approximately 0.254 cm (0.100 inches) and in a variation each leg 78A, 78B, 80A, 80B is concentric around the center point of a cross section taken perpendicular to the longitudinal axis of the jaws 48, 50 in a closed orientation. The radius of curvature of the outer surface of the first longer legs 78A, 78B is approximately 0.292 cm (0.115 inches). The radius of curvature of the outer surface at the intersections with the 82 base is approximately 0.023 cm (0.009 inches). The radius of curvature of the inner surface of the second shorter legs 80A, 80B is approximately 0.165 cm (0.065 inches). The distance between the side surfaces or the thickness of the legs is approximately 0.025 cm (0.010 inches). The distance between the inner surface and the outer surface or width of the legs is approximately 0.038 cm (0.015 inches).
Con respecto a las Figuras 28-30, se muestra la grapa 54 de las Figuras 24-27 en una segunda o deformada configuración luego del accionamiento completo de la grapadora. El despliegue de la grapa 54 de cuatro hileras, que se analizará con más detalle más adelante, resulta en que las patas más cortas 80A, 80B hagan contacto con la superficie de yunque 74 y se deformen. Las patas más cortas 80A, 80B son desviadas verticalmente hacia abajo hacia la base 82 y lateralmente fuera de la base 82, fuera del eje longitudinal de la grapa 54. Las patas más cortas 80A, 80B se doblan para formar un bucle con forma de C con las puntas 88A, 88B que apuntan sustancialmente hacia abajo. Las puntas 88A, 88B no están ubicadas por encima de la base 82 en la configuración deformada. Las patas más largas 78A, 78B harán contacto con la superficie de yunque 74 y con el movimiento continuado del deslizador 32 se deformarán de forma tal que las patas más largas 78A, 78B se desvían verticalmente hacia abajo y lateralmente hacia el eje longitudinal de la base 82. Las patas más largas 78A, 78B se doblan para formar un bucle más profundo respecto a las patas más cortas deformadas 80A, 80B. Además, las puntas 86A, 86B de las patas más largas 78A, 78B están verticalmente más cerca de la base 82 que las puntas 88A, 88B de las patas más cortas 80A, 80B. Las puntas 86A, 86B de las patas más largas 78A, 78B se encuentran por encima de la base 82 en la configuración deformada. Todas las patas 78A, 78B, 80A, 80B están desviadas en la misma dirección. Por ejemplo, como se muestra en la vista de extremo de la Figura 30, las patas 78A, 78B, 80A, 80B están desviadas hacia la derecha. Los compartimientos en la superficie de yunque 74 que están alineados con la abertura de salida en la superficie superior de la mandíbula inferior, guían y ayudan en la deformación adecuada de una grapa.With reference to Figures 28-30, staple 54 of Figures 24-27 is shown in a second or deformed configuration after complete actuation of the stapler. Deployment of the four row staple 54, which will be discussed in more detail later, results in the shorter legs 80A, 80B contacting the anvil surface 74 and becoming deformed. The shorter legs 80A, 80B are deflected vertically downward toward the base 82 and laterally away from the base 82, away from the longitudinal axis of the staple 54. The shorter legs 80A, 80B are bent to form a C-shaped loop. with tips 88A, 88B pointing substantially downward. Tips 88A, 88B are not located above base 82 in the deformed configuration. The longer legs 78A, 78B will contact the anvil surface 74 and with continued movement of the slider 32 will deform such that the longer legs 78A, 78B deflect vertically downward and laterally toward the longitudinal axis of the base. 82. The longer legs 78A, 78B bend to form a deeper loop relative to the shorter deformed legs 80A, 80B. Furthermore, the tips 86A, 86B of the longer legs 78A, 78B are vertically closer to the base 82 than the tips 88A, 88B of the shorter legs 80A, 80B. Tips 86A, 86B of longer legs 78A, 78B are above base 82 in the deformed configuration. All legs 78A, 78B, 80A, 80B are offset in the same direction. For example, as shown in the end view of Figure 30, legs 78A, 78B, 80A, 80B are offset to the right. Compartments in the anvil surface 74 that are aligned with the exit opening in the upper surface of the lower jaw guide and assist in proper deformation of a staple.
Una grapa 54 de cuatro hileras que tiene una base 82 más angosta se muestra en una configuración no deformada o abierta en las Figuras 31-33 donde números de referencia similares se utilizan para describir partes similares. En esta variación de la grapa 54, la base 82 tiene un ancho de aproximadamente 0,020 pulgadas y una longitud de aproximadamente 0,100 pulgadas. La distancia lateral entre la superficie interna de las patas más largas 78A, 78B y la superficie interna de las patas más cortas 80A, 80B es sustancialmente la misma que la de la grapa 54 que se muestra en las Figuras 24-30. Por lo tanto, encajará adentro del canal 53 del mismo tamaño y la base 82 está configurada para leva contra el pulsador 58. La grapa 54 de las Figuras 31-33 tiene un radio de curvatura interior en las patas 78A, 78B, 80A, 80B que sustancialmente coincide con el grosor de la base 82. Las patas 78A, 78B, 80A, 80B son curvas de la misma manera. Las Figuras 34-36 muestran la grapa 54 en una segunda o deformada configuración luego del accionamiento completo de la grapadora. El despliegue de la grapa 54 de cuatro hileras, resulta en que las patas más cortas 80A, 80B hacen contacto con la superficie de yunque 74 y se deformen. Las patas más cortas 8 0 a , 80B son desviadas verticalmente hacia abajo hacia la base 82 y lateralmente fuera de la base 82, fuera del eje longitudinal de la grapa 54. Las patas más cortas 80A, 80B se doblan para formar un bucle con forma de C con las puntas 88A, 88B que apuntan sustancialmente hacia abajo. Las patas más largas 78A, 78B harán contacto con la superficie de yunque 74 y con el movimiento continuado del deslizador 32 se deformarán de forma tal que las patas más largas 78A, 78B se desvían verticalmente hacia abajo hacia la base 82 y lateralmente hacia el eje longitudinal de la base 82. Las patas más largas 78A, 78B se doblan para formar un bucle más profundo más grande respecto a las patas más cortas deformadas 80A, 80B. Además, las puntas 86A, 86B de las patas más largas 78A, 78B están verticalmente más cerca de la base 82 que las puntas 88A, 88B de las patas más cortas 80A, 80B. Las patas más largas 78A, 78B tienen un radio de curvatura más grande respecto a las patas más cortas 80A, 80B. Todas las patas 78A, 78B, 80A, 80B están desviadas en la misma dirección. Por ejemplo, todas las patas 78A, 78B, 80A, 80B están desviadas al lado derecho o a la derecha del eje longitudinal de la grapa cuando se visualizan desde el extremo en la Figura 36. Debido a que la base 82 es más angosta, las puntas 86A, 86B, 88A, 88B se encuentran a la derecha de la base 82 y no están ubicadas por encima de la base 82. Los compartimientos en la superficie de yunque 74 que están alineados con la abertura de salida en la superficie superior de la mandíbula inferior, guían y ayudan en la deformación adecuada de una grapa.A four row staple 54 having a narrower base 82 is shown in an undeformed or open configuration in Figures 31-33 where like reference numerals are used to describe like parts. In this variation of staple 54, base 82 has a width of approximately 0.020 inches and a length of approximately 0.100 inches. The lateral distance between the inner surface of the longer legs 78A, 78B and the inner surface of the shorter legs 80A, 80B is substantially the same as that of clip 54 shown in Figures 24-30. Therefore, it will fit inside channel 53 of the same size and base 82 is configured to cam against pusher 58. Clamp 54 of Figures 31-33 has an inside radius of curvature on legs 78A, 78B, 80A, 80B which substantially matches the thickness of the base 82. The legs 78A, 78B, 80A, 80B are curved in the same way. Figures 34-36 show staple 54 in a second or deformed configuration after complete actuation of the stapler. Deployment of the four-row staple 54 results in the shorter legs 80A, 80B contacting the anvil surface 74 and deforming. The shorter legs 8 0 to , 80B are deflected vertically downward toward the base 82 and laterally away from the base 82, away from the longitudinal axis of the staple 54. The shorter legs 80A, 80B are bent to form a shaped loop. of C with tips 88A, 88B pointing substantially downward. The longer legs 78A, 78B will contact the anvil surface 74 and with continued movement of the slider 32 they will deform such that the longer legs 78A, 78B deflect vertically down towards the base 82 and laterally towards the axis. lengthwise of the base 82. The longer legs 78A, 78B bend to form a larger, deeper loop relative to the shorter deformed legs 80A, 80B. Furthermore, the tips 86A, 86B of the longer legs 78A, 78B are vertically closer to the base 82 than the tips 88A, 88B of the shorter legs 80A, 80B. The longer legs 78A, 78B have a larger radius of curvature relative to the shorter legs 80A, 80B. All legs 78A, 78B, 80A, 80B are offset in the same direction. For example, all legs 78A, 78B, 80A, 80B are offset to the right or right side of the longitudinal axis of the staple when viewed from the end in Figure 36. Because the base 82 is narrower, the tips 86A, 86B, 88A, 88B are located to the right of the base 82 and are not located above the base 82. The compartments in the anvil surface 74 that are aligned with the outlet opening in the upper surface of the jaw bottom, guide and assist in the proper deformation of a staple.
Con respecto a las Figuras 37-40, otra grapa 54 según la presente invención se describirá mediante el uso de números de referencia similares para describir partes similares. La grapa 54 es una grapa 54 de cuatro hileras que se muestra en su configuración no deformada o abierta y es sustancialmente similar a la grapa 54 de las Figuras 24 30. La grapa 54 de cuatro hileras incluye dos primeras patas más largas 78A, 78B y dos segundas patas más cortas 80A, 80B interconectadas por una base 82. Las dos patas más largas 78A, 78B están escalonadas con respecto a las dos segundas patas más cortas 80A, 80B. Cada una de las patas 78A, 78B, 80A, 80B tiene su respectiva punta 86A, 86B, 88A, 88B. La grapa 54 de las Figuras 37-40, incluye además múltiples muescas 90 de patas formadas en las patas 78A, 78B, 80A, 80B. Las muescas 90 de la pata se extienden hacia adentro desde las superficies laterales de las patas para crear concentraciones de tensiones de forma tal que cuando se desvían contra la superficie de yunque 74, las patas tenderán a doblarse en la ubicación de las muescas 90 de la pata. A lo largo de la longitud de una pata, al menos un par de muescas 90 de la pata se forma en donde cada muesca 90 de la pata del par se ubica opuesta una de otra y a la misma altura con respecto a la base 82. Se muestra que las patas más largas 78A, 78B tienen tres pares de muescas 90A, 90B y 90C de la pata. El primer par de muescas 90A de la pata se ubica justo por debajo de la punta 86A y dos otros pares de muescas 90B, 90C de la pata se ubican más abajo a lo largo de cada pata 78A, 78B. Cada una de las segundas patas más cortas 80A, 80B se forman con un único par de muescas 90D de la pata ubicadas justo por debajo de la punta 88. Las muescas 90 de la pata están configuradas de forma tal que el despliegue de la grapa 54 contra la superficie de yunque 74 forma una configuración deformada predeterminada como se representa en las Figuras 41-43. Las patas se muestran dobladas en la ubicación de las muescas 90 para formar bucles con forma de C segmentados en donde las partes de la pata entre las muescas 90 de la pata definen segmentos de la configuración deformada. En la configuración deformada, todas las patas 78A, 78B, 80A, 80B están dobladas en la misma dirección estando las patas más cortas 80A, 80B desviadas lateralmente fuera del eje longitudinal de la grapa 54 y las patas más largas 78A, 78B desviadas hacia el eje longitudinal con las puntas 86A, 86B, 88A, 88B desviadas verticalmente hacia abajo en el tejido. La desviación segmentada a lo largo de las muescas 90 de la pata ayuda a inclinar las puntas afiladas en el tejido penetrante así como a crear una altura de grapa deformada que pueda alojar tejido dentro de la grapa 54 sin seccionar el tejido que surge de la deformación desigual. Las muescas 90 de la pata proporcionan una curvatura con forma de C en las patas que está formada de forma consistente y fiable.With respect to Figures 37-40, another staple 54 in accordance with the present invention will be described using like reference numerals to describe like parts. Staple 54 is a four-row staple 54 shown in its undeformed or open configuration and is substantially similar to staple 54 of Figures 24-30. Four-row staple 54 includes two longer first legs 78A, 78B and two second shorter legs 80A, 80B interconnected by a base 82. The two longer legs 78A, 78B are staggered with respect to the two second shorter legs 80A, 80B. Each of the legs 78A, 78B, 80A, 80B has its respective tip 86A, 86B, 88A, 88B. Staple 54 of Figures 37-40 further includes multiple leg notches 90 formed in legs 78A, 78B, 80A, 80B. The leg notches 90 extend inwardly from the side surfaces of the legs to create stress concentrations such that when deflected against the anvil surface 74, the legs will tend to bend at the location of the notches 90 of the leg. paw. Along the length of a leg, at least one pair of leg notches 90 is formed where each leg notch 90 of the pair is located opposite each other and at the same height relative to the base 82. shows that the longer legs 78A, 78B have three pairs of leg notches 90A, 90B and 90C. The first pair of leg notches 90A are located just below tip 86A and two other pairs of leg notches 90B, 90C are located further down each leg 78A, 78B. Each of the second shorter legs 80A, 80B is formed with a single pair of leg notches 90D located just below the tip 88. The leg notches 90 are configured such that deployment of staple 54 against anvil surface 74 forms a predetermined deformed configuration as depicted in Figures 41-43. The legs are shown bent at the location of the notches 90 to form segmented C-shaped loops where the leg portions between the leg notches 90 define segments of the deformed configuration. In the deformed configuration, all legs 78A, 78B, 80A, 80B are bent in the same direction with the shorter legs 80A, 80B offset laterally away from the longitudinal axis of staple 54 and the longer legs 78A, 78B offset toward the longitudinal axis with tips 86A, 86B, 88A, 88B offset vertically downward in the tissue. Segmented deflection along leg notches 90 helps to angle sharp tips into penetrating tissue as well as create a deformed staple height that can accommodate tissue within staple 54 without severing tissue arising from deformation unequal. The leg notches 90 provide a C-shaped bend in the legs that is consistently and reliably formed.
En cualquiera de las variaciones de la grapa, las patas de la grapa 78A, 78B, 80A, 80B pueden incluir al menos una lengüeta o protuberancia tipo gancho lateral. La al menos una lengüeta puede proporcionarse en cualquier lado a lo largo de la longitud de la pata inclusive cerca del extremo distal de cada pata y formarse en superficies laterales. Las lengüetas ayudan a proporcionar una fijación mecánica aumentada de la grapa en el tejido y pueden formarse en cualquiera o en todas las cuatro patas y en la superficie interna, superficie externa y/o superficies laterales. En una variación, al menos una lengüeta se forma en la superficie interna de las primeras patas más largas 78A, 78B y la superficie externa de las segundas patas más cortas 80A, 80B. Múltiples lengüetas a lo largo de una o más patas también son posibles ya que son lengüetas más pequeñas como lengüetas de tamaño micro y nano.In any of the variations of the staple, the staple legs 78A, 78B, 80A, 80B may include at least one side hook-type tab or protrusion. The at least one tab may be provided on either side along the length of the leg including near the distal end of each leg and formed on side surfaces. The tabs help provide increased mechanical fixation of the staple in tissue and can be formed on any or all of the four legs and on the inner surface, outer surface, and / or side surfaces. In a variation, at least one tab is formed on the inner surface of the first longer legs 78A, 78B and the outer surface of the second shorter legs 80A, 80B. Multiple tabs along one or more legs are also possible as they are smaller tabs like micro and nano size tabs.
Las grapas 54 pueden formarse fijas a una estructura principal en un estilo espina de pescado para facilitar la fabricación, ensamblaje y manipulación. Se proporciona una hoja o bloque de metal tal como acero quirúrgico, acero inoxidable o titanio y múltiples grapas 54 se cortan en la hoja de metal en una máquina por mecanizado de descarga eléctrica (EDM) por alambre fino. Las grapas 54 también pueden formarse mediante el uso de un equipo micro-water jet, fotograbado o mediante estampación. Las grapas 54 pueden formarse con patas dobladas o la torsión de las patas se lleva a cabo en una etapa independiente. Las grapas 54 permanecen conectadas a la estructura principal a través de solapas conectoras angostas hasta que las grapas 54 se desprenden en las solapas y luego se cargan en un cartucho de grapas. Luego de que se desprende una grapa 54, una parte de la solapa conectora puede permanecer fija a la grapa 54. La solapa remanente puede funcionar de forma ventajosa como una lengüeta para aumentar la fijación mecánica en el tejido capturado dentro de una grapa 54 cerrada luego del despliegue. Además, la estructura principal puede ser una ayuda en el almacenamiento de grapas 54 y en el ensamblaje de cartuchos de grapas.Staples 54 can be formed attached to a main frame in a herringbone style to facilitate fabrication, assembly, and handling. A sheet or block of metal such as surgical steel, stainless steel or titanium is provided and multiple staples 54 are cut into the sheet of metal on a fine wire electrical discharge machining (EDM) machine. Staples 54 can also be formed by use of micro-water jet equipment, gravure, or by stamping. The staples 54 can be formed with bent legs or the twisting of the legs is carried out in a separate step. Staples 54 remain connected to the main frame through narrow connector flaps until staples 54 are dislodged at the flaps and then loaded into a staple cartridge. After a staple 54 is detached, a portion of the connector flap may remain attached to staple 54. The remaining flap may advantageously function as a tab to increase mechanical fixation on captured tissue within a then closed staple 54. of deployment. In addition, the main frame can be an aid in staple storage 54 and staple cartridge assembly.
Un cartucho de grapas en la forma de una única unidad se inserta en una parte receptora del cartucho de grapas de la mandíbula inferior 50. El cartucho de grapas también puede tener la forma de dos unidades en las que cada unidad tiene dos ranuras a ser cargadas en cualquiera de los lados del canal 55 de la mandíbula inferior central. Cada cartucho puede incluir un cubreobjetos de papel (no se muestra) que cubre los canales 53 de la grapa para retener las grapas 54 durante el almacenamiento y manipulación. El cubreobjetos luego se remueve al desprenderse justo antes o luego de la instalación del cartucho.A staple cartridge in the form of a single unit is inserted into a receiving part of the lower jaw staple cartridge 50. The staple cartridge may also be in the form of two units in which each unit has two slots to be loaded. on either side of canal 55 of the central lower jaw. Each cartridge may include a paper coverslip (not shown) that covers the staple channels 53 to retain the staples 54 during storage and handling. The coverslip is then removed by peeling off just before or after cartridge installation.
Cada cartucho de grapas también puede contener una viga en I 32 y pulsadores 58 dispuestos dentro del cartucho. En otra variación del cartucho, el cartucho de grapas se instala previamente dentro del ensamblaje de cartucho de grapadora 14 y luego de haberse gastado las grapas 54 todo el ensamblaje del cartucho de grapadora 14 se remueve y se descarta y un nuevo ensamblaje de cartucho de grapadora 14 se conecta al ensamblaje de mango 12 para un grapado continuo. Al estar el ensamblaje de cartucho de grapas 14 conectado al ensamblaje de mango 12, el eje accionador 22 se conecta a un eje accionador dentro del ensamblaje de mango 12. El ensamblaje de mango 12 luego es utilizado para operar la grapadora 10 en tres funciones o modos de operación diferentes. El primer modo permite al usuario abrir y cerrar las mandíbulas 48, 50 del efector terminal 18. El segundo modo dispara las grapas y el tercer modo de operación hace volver la viga en I 32 a su posición proximal original luego del disparo de las grapas. Un mecanismo de bloqueo bloquea la viga en I 32 evitando que se mueva hacia adelante dentro de un cartucho ya gastado o parcialmente gastado.Each staple cartridge may also contain an I-beam 32 and pushbuttons 58 disposed within the cartridge. In another variation of the cartridge, the staple cartridge is pre-installed within the stapler cartridge assembly 14 and after the staples 54 have been spent the entire staple cartridge assembly 14 is removed and discarded and a new stapler cartridge assembly 14 connects to handle assembly 12 for continuous stapling. As the staple cartridge assembly 14 is connected to the handle assembly 12, the drive shaft 22 connects to a drive shaft within the handle assembly 12. The handle assembly 12 is then used to operate the stapler 10 in three functions or different modes of operation. The first mode allows the user to open and close the jaws 48, 50 of the end effector 18. The second mode fires the staples and the third mode of operation returns the I-beam 32 to its original proximal position after firing of the staples. A locking mechanism locks the I-beam 32 preventing it from moving forward within an already spent or partially spent cartridge.
El ensamblaje de mango 12 incluye un mango conectado a un propulsor delantero que se acopla a un diente delantero en el eje accionador 22. Cuando el mango está oprimido, el accionador se mueve ligeramente hacia adelante que a su vez mueve el eje accionador 22 del ensamblaje de cartucho de grapadora 14 hacia adelante. Dado que el eje accionador 22 está conectado a la viga en I 32, la viga en I 32 avanza hacia adelante con el descenso del mango. A medida que avanza la viga en I 32, el extremo frontal biselado 40 de la parte superior 34 de la viga en I 32 entra al conducto o ranura central 76 en la mandíbula superior 48 que desvía la mandíbula superior 48 abierta y sesgada por resorte hacia abajo desde una posición abierta hacia una posición cerrada.Handle assembly 12 includes a handle connected to a front drive that engages a front tooth on drive shaft 22. When the handle is depressed, the drive moves slightly forward which in turn moves drive shaft 22 of the assembly. stapler cartridge 14 forward. Since the drive shaft 22 is connected to the I-beam 32, the I-beam 32 advances forward with the descent of the handle. As the I-beam 32 advances, the beveled front end 40 of the top 34 of the I-beam 32 enters the central passage or slot 76 in the upper jaw 48 which biases the open, spring-biased upper jaw 48 toward down from an open position to a closed position.
La mandíbula superior 48 está conectada a la mandíbula inferior 50 con un perno de forma tal que la mandíbula superior 48 pivota con respecto a la mandíbula inferior 50. Los resortes se incluyen para crear un sesgo por resorte que impulsa a la mandíbula superior 48 hacia una posición abierta con respecto a la mandíbula inferior 50. Cuando se libera el mango, el eje accionador 22 se mueve proximalmente presionando la viga en I 32 también proximalmente permitiendo que el sesgo por resorte abra las mandíbulas a medida que la parte superior 34 de la viga en I sale del conducto 76. El usuario puede abrir y cerrar las mandíbulas del efector terminal 18 al presionar y liberar el mango 12 para posicionar el tejido dirigido entre las mandíbulas superior e inferior de la grapadora 10. En una posición cerrada, la distancia a lo largo del hueco entre la mandíbula superior 48 y la mandíbula inferior 50 es aproximadamente 0,076 cm a 0,152 cm (0,030-0,060 pulgadas).The upper jaw 48 is connected to the lower jaw 50 with a bolt such that the upper jaw 48 pivots with respect to the lower jaw 50. The springs are included to create a spring-loaded bias that biases the upper jaw 48 toward a open position relative to the lower jaw 50. When the handle is released, the actuator shaft 22 moves proximally pressing the I-beam 32 also proximally allowing the spring bias to open the jaws as the top 34 of the beam at I exits conduit 76. The user can open and close the jaws of end effector 18 by depressing and releasing handle 12 to position targeted tissue between the upper and lower jaws of stapler 10. In In a closed position, the distance along the gap between the upper jaw 48 and the lower jaw 50 is approximately 0.076 cm to 0.152 cm (0.030-0.060 inches).
Luego de que las mandíbulas están cerradas en posición en la ubicación de tejido dirigido, la grapadora 10 cambia para operar en modo disparo al oprimir el botón de disparo en el ensamblaje de mango 12. El botón de disparo desacopla un propulsor abierto desde el eje accionador liberándolo para el movimiento longitudinal. El propulsor abierto se acopla con los dientes del eje accionador. El propulsor abierto se desacopla desde los dientes del eje accionador con el botón de disparo oprimido. Al estar el propulsor abierto desacoplado, el mango desencadenante gira hacia afuera y el propulsor delantero se acopla con dientes delanteros en el eje accionador. Al oprimir el mango hace que avance el eje accionador hacia adelante a medida que el propulsor delantero se acopla libremente a los dientes con cada apretón del mango desencadenante. El mango se aprieta múltiples veces para hacer que la viga en I 32 avance todo el recorrido hasta el extremo distal del efector terminal 18.After the jaws are closed in position at the targeted tissue location, the stapler 10 switches to operate in firing mode by depressing the firing button on the handle assembly 12. The firing button disengages an open impeller from the drive shaft. releasing it for longitudinal movement. The open impeller engages the teeth of the drive shaft. The open impeller disengages from the drive shaft teeth with the fire button depressed. With the open impeller disengaged, the trigger handle rotates outward and the front impeller engages front teeth on the drive shaft. Depressing the handle causes the drive shaft to advance forward as the front impeller loosely engages the teeth with each squeeze of the trigger handle. The handle is squeezed multiple times to advance the I-beam 32 all the way to the distal end of end effector 18.
Las Figuras 44-46 son vistas transversales semitransparentes del efector terminal 18 estando las mandíbulas 48, 50 en una posición cerrada tomadas de forma perpendicular al eje longitudinal en tres etapas progresivas del despliegue de grapas. La Figura 44 muestra un par de grapas 54 que se encuentra en canales 53 receptores de grapas circunferenciales. La base 82 de cada grapa 54 está en contacto con la superficie superior 60 del pulsador 58. A medida que la viga en I 32 es avanzada, el pulsador 58 moverá las grapas 54 a lo largo de la trayectoria circunferencial hacia arriba y hacia afuera desde la mandíbula inferior 50 y hacia el hueco entre la mandíbula superior 48 y la mandíbula inferior 50 como se muestra en la Figura 45. La Figura 45 ilustra las patas de la grapa 78, 80, en particular, las puntas de las patas 78, 80 que se acercan a la superficie de yunque 74. La superficie de yunque 74 se muestra en la Figura 45 a ser proporcionada con compartimientos formadores de grapas cóncavos que ayudan en la desviación y deformación de las patas de las grapas 78, 80 respecto a la base 82 de la grapa. Dado que las patas de la grapa más largas 78 harán contacto primero con la superficie de yunque 74 antes de que las patas más cortas 80 hagan contacto con la superficie de yunque 74, el despliegue o fuerza de accionamiento requerido para doblar las patas de la grapa 78, 80 se reducirá de forma ventajosa dado que las dos patas más largas 78 de la grapa 54 ya habrán sido ligeramente desviadas antes de que se haga contacto con las patas más cortas 80 y estén forzadas a la desviación. La fuerza de disparo reducida permite un despliegue más uniforme y un aumento en la facilidad del accionamiento. Además, el disparo circunferencial permite de forma ventajosa que la grapadora incluya una fila adicional de grapas mientras que mantiene la fuerza de accionamiento constante. Dado que las patas de la grapa 78, 80 se curvan antes de la deformación, la fuerza requerida para desplegar la grapa se reduce de forma ventajosa dado que las patas curvas no requieren una mayor fuerza asociada con el pandeo de las patas de la grapa. Las patas de la grapa curvas se doblan simplemente en la configuración cerrada. Un mayor avance de la viga en I 32 en la dirección distal mueve los pulsadores 58 en cualquiera de los lados de la viga en I 32 junto con sus grapas 54 respectivas a través además de canales 53 circunferenciales y hacia arriba contra la superficie de yunque 74 y en una configuración deformada como se muestra en la Figura 46. La Figura 46 ilustra una grapa 54 totalmente formada que se encuentra en el hueco entre la mandíbula superior 48 y la mandíbula inferior 50. El hueco proporciona espacio para recibir el tejido diana. Las Figuras 47-48 ilustran una vista transversal lateral parcialmente transparente y una vista superior transversal parcial de la viga en I 32 que avanzadas a lo largo de la longitud del efector terminal 18 estando las mandíbulas superior e inferior 48, 50 en una configuración cerrada. La Figura 47 ilustra las diversas posiciones de las grapas 54 y los pulsadores 58 con respecto a la posición de la viga en I 32. La Figura 49 ilustra una vista en perspectiva superior, de sección parcial del efector terminal 18 con la viga en I 32 avanzada a lo largo del canal 55 de la mandíbula inferior central que despliega y deforma las grapas 54 a lo largo de la trayectoria de avance. Se muestra que las grapas 54 proximales a la parte inferior 36 de la viga en I 32 están totalmente deformadas. Las grapas 54 en contacto con la superficie principal 44 de la viga en I 32 se muestran en diversas etapas de despliegue y deformación. Las grapas 54 distales a la superficie principal 44 de la viga en I 32 se muestran residentes dentro de los canales 53 de la grapa antes del contacto con la viga en I 32 y el movimiento por fuera de los canales 53. En esta variación, las patas de la grapa 78, 80 de una grapa de cuatro hileras están desviadas en una dirección que es transversal al eje longitudinal del efector terminal 18 y también transversal a la longitud de la base 82 de la grapa.Figures 44-46 are semi-transparent cross-sectional views of end effector 18 with jaws 48, 50 in a closed position taken perpendicular to the longitudinal axis in three progressive stages of staple deployment. Figure 44 shows a pair of staples 54 found in circumferential staple receiving channels 53. The base 82 of each staple 54 is in contact with the upper surface 60 of the pusher 58. As the I-beam 32 is advanced, the pusher 58 will move the staples 54 along the circumferential path up and out from the lower jaw 50 and towards the gap between the upper jaw 48 and the lower jaw 50 as shown in Figure 45. Figure 45 illustrates the legs of the staple 78, 80, in particular the tips of the legs 78, 80 approaching the anvil surface 74. The anvil surface 74 is shown in Figure 45 to be provided with concave staple-forming compartments that aid in deflection and deformation of the staple legs 78, 80 from the base. 82 of the staple. Since the longer staple legs 78 will first contact the anvil surface 74 before the shorter legs 80 make contact with the anvil surface 74, the deployment or actuation force required to bend the staple legs 78, 80 will be advantageously reduced since the two longer legs 78 of the staple 54 will already have been slightly deflected before the shorter legs 80 are contacted and are forced to deflect. The reduced firing force allows for a more uniform deployment and increased ease of actuation. Furthermore, the circumferential firing advantageously allows the stapler to include an additional row of staples while keeping the actuation force constant. Since the legs of the staple 78, 80 are bent prior to deformation, the force required to deploy the staple is advantageously reduced since the curved legs do not require a greater force associated with buckling of the legs of the staple. The curved staple legs are simply bent in the closed configuration. Further advancement of the I-beam 32 in the distal direction moves the pushers 58 on either side of the I-beam 32 along with their respective clips 54 through further circumferential channels 53 and up against the anvil surface 74 and in a deformed configuration as shown in Figure 46. Figure 46 illustrates a fully formed staple 54 located in the gap between the upper jaw 48 and the lower jaw 50. The gap provides space to receive the target tissue. Figures 47-48 illustrate a partially transparent side cross-sectional view and a partial cross-sectional top view of the I-beam 32 advanced along the length of the end effector 18 with the upper and lower jaws 48, 50 in a closed configuration. Figure 47 illustrates the various positions of clips 54 and pushbuttons 58 with respect to the position of the I-beam 32. Figure 49 illustrates a partially sectioned, top perspective view of the end-effector 18 with the I-beam 32 advanced along channel 55 of the central lower jaw that deploys and deforms staples 54 along the path of advancement. Staples 54 proximal to bottom 36 of I-beam 32 are shown to be fully deformed. Staples 54 in contact with major surface 44 of I-beam 32 are shown in various stages of deployment and deformation. Staples 54 distal to major surface 44 of I-beam 32 are shown to be resident within channels 53 of the staple prior to contact with I-beam 32 and movement away from channels 53. In this variation, the Legs of the staple 78, 80 of a four-row staple are offset in a direction that is transverse to the longitudinal axis of the end effector 18 and also transverse to the length of the base 82 of the staple.
Con respecto a continuación a las Figuras 50-53, se describirá una grapa de doble hilera 100 según la presente invención. La grapa de doble hilera 100 se muestra en su configuración no deformada o abierta. La grapa 100 incluye dos patas 102 interconectadas por una base 104. La base 104 funciona como una superficie de contacto para el acoplamiento con el pulsador 58. Las patas 102 se extienden hacia arriba desde la base 104 y se curvan a un lado como se puede observar claramente en la Figura 52. La curvatura de las patas de la grapa 102 corresponde a la curvatura de los canales 53 circunferenciales en los que se disponen y por los que se desplazan cuando son impulsadas por los pulsadores 58 que entran consecutivamente en contacto con la viga en I 32. Por lo tanto, la curvatura de las patas de la grapa 102 también corresponde sustancialmente a la circunferencia de la mandíbula inferior 50. Las dos superficies laterales de cada pata convergen para formar una punta afilada 106 en una intersección de línea en el extremo distal libre de la pata 102. La punta 106 comienza en donde las superficies laterales comienzan a estrecharse o disminuir en un área transversal en una dirección distalmente a lo largo de la pata 102. Las punta 102 puede formarse de cualquier manera y puede tener cualquier otra forma geométrica que sea adecuada para perforar y penetrar tejido a través del cual se suministra la grapa 100.With reference now to Figures 50-53, a double row staple 100 according to the present invention will be described. The double row staple 100 is shown in its undeformed or open configuration. Staple 100 includes two legs 102 interconnected by base 104. Base 104 functions as a contact surface for engagement with pushbutton 58. Legs 102 extend upward from base 104 and curve to one side as can be see clearly in Figure 52. The curvature of the legs of the staple 102 corresponds to the curvature of the circumferential channels 53 in which they are arranged and through which they move when they are driven by the pushbuttons 58 that consecutively come into contact with the I-beam 32. Therefore, the curvature of the legs of the staple 102 also corresponds substantially to the circumference of the lower jaw 50. The two side surfaces of each leg converge to form a sharp point 106 at a line intersection at the free distal end of leg 102. Tip 106 begins where the lateral surfaces begin to taper or taper in a cross-sectional area in a direction distally to along leg 102. Tips 102 can be formed in any way and can have any other geometric shape that is suitable for piercing and penetrating tissue through which staple 100 is delivered.
Con respecto aún a las Figuras 50-53, las patas 102 tienen una longitud de aproximadamente 0,254 cm (0,100 pulgadas) con un ángulo central de aproximadamente 62 grados. La longitud total de la base 82 es de aproximadamente 0,254 cm (0,100 pulgadas) y cada pata 102 es concéntrica alrededor del punto central de una sección transversal tomada de forma perpendicular al eje longitudinal de las mandíbulas 48, 50 en una orientación cerrada. El radio de curvatura de la superficie externa de las primeras patas más largas 78A, 78B es de aproximadamente 0,292 cm (0,115 pulgadas). La distancia entre las superficies laterales o grosor de las patas es de aproximadamente 0,018 cm (0,007 pulgadas). La distancia entre la superficie interna y la superficie externa o ancho de las patas es de aproximadamente 0,051 cm (0,020 pulgadas).Still referring to Figures 50-53, legs 102 are about 0.100 inches long with a center angle of about 62 degrees. The total length of the base 82 is approximately 0.254 cm (0.100 inches) and each leg 102 is concentric about the center point of a cross section taken perpendicular to the longitudinal axis of the jaws 48, 50 in a closed orientation. The radius of curvature of the outer surface of the first longer legs 78A, 78B is approximately 0.292 cm (0.115 inches). The distance between the side surfaces or thickness of the legs is approximately 0.018 cm (0.007 inches). The distance between the inner surface and the outer surface or width of the legs is approximately 0.051 cm (0.020 inches).
Con respecto a las Figuras 54-56, se muestra la grapa 100 de las Figuras 50-53 en una segunda o deformada configuración luego del accionamiento completo de la grapadora. El despliegue de la grapa de doble hilera 100, que se analizará con más detalle más adelante, da como resultado que las patas 102 hagan contacto con la superficie de yunque 74 de la mandíbula superior 48 y se deformen. Las patas 102 están desviadas entre sí de forma tal que las puntas 106 están inclinadas verticalmente hacia abajo hacia la base 82. Las patas 102 harán contacto con la superficie de yunque 74 en donde los compartimientos de yunque que están alineados con las aberturas de salida en la superficie superior de la mandíbula inferior 50 pueden formarse para guiar la deformación adecuada de las patas de la grapa 102. La grapa deformada 100 tiene una configuración esencialmente con forma de B.With reference to Figures 54-56, the staple 100 of Figures 50-53 is shown in a second or deformed configuration after complete actuation of the stapler. Deployment of the double row staple 100, which will be discussed in more detail later, results in the legs 102 making contact with the anvil surface 74 of the upper jaw 48 and becoming deformed. Legs 102 are offset from one another such that tips 106 are inclined vertically downward toward base 82. Legs 102 will contact anvil surface 74 where the anvil compartments that are aligned with outlet openings at the upper surface of the lower jaw 50 may be formed to guide proper deformation of the legs of the staple 102. The deformed staple 100 has an essentially B-shaped configuration.
Las Figuras 57-59 son vistas transversales semitransparentes del efector terminal 18 estando las mandíbulas superior e inferior 48, 50 en una posición cerrada tomada de forma perpendicular al eje longitudinal en tres etapas progresivas del despliegue de grapas. La Figura 57 muestra cuatro grapas de doble hilera 100 que residen en dos canales 53 receptores de grapas circunferenciales en cualquiera de los lados de la viga en I 32. La base 104 de cada grapa 100 está en contacto con la superficie superior 60 del pulsador 58. A medida que la viga en I 32 está avanzada, el pulsador 58 moverá las grapas 100 a lo largo de la trayectoria circunferencial hacia arriba y hacia afuera desde la mandíbula inferior 50 y hacia el hueco entre la mandíbula superior 48 y la mandíbula inferior 50 como se muestra en la Figura 58. La Figura 58 ilustra las patas de la grapa 102, en particular, las puntas de las patas 106 que se acercan a la superficie de yunque 74. La superficie de yunque 74 se muestra en las Figuras 57-59 a ser proporcionada con compartimientos formadores de grapas 108 que ayudan en la desviación y deformación de las patas de la grapa 102 respecto a la base de la grapa 104. Cada compartimiento de grapa 108 incluye una superficie de contacto de grapa 110 que es sustancialmente perpendicular a la circunferencia de los canales 53 de la grapa de forma tal que una grapa curva 100 que sale de un canal 53 circunferencial entra en contacto con la superficie de contacto de la grapa 110 en una orientación perpendicular. Un mayor avance de la viga en I 32 en la dirección distal mueve los pulsadores 58 en cualquiera de los lados de la viga en I 32 y sus grapas 100 respectivas a través además de canales 53 circunferenciales y hacia arriba contra los compartimientos de la grapa 108 en la superficie de yunque 74 y en una configuración deformada como se muestra en la Figura 59. La Figura 59 ilustra una grapa 100 totalmente formada que reside en el hueco entre la mandíbula superior 48 y la mandíbula inferior 50. El hueco proporciona espacio para recibir el tejido diana. La Figura 60 ilustra el efector terminal 18 con la viga en I 32 parcialmente avanzado a lo largo del efector terminal 18. Dos filas de grapas de doble hilera 100 se muestran en cualquiera de los lados de la viga en I 32 en diversas etapas del despliegue. Las grapas 100 se muestran emergentes de los canales 53 de la grapa en la mandíbula inferior 50. Las grapas 100 que están ubicadas distalmente de la viga en I 32 solamente han surgido parcialmente o no han surgido aun desde los canales 32 respecto a las grapas 100 proximales a la viga en I 32. Para mayor claridad, las grapas 100 ubicadas proximalmente a la viga en I 32 no se muestran deformadas en la Figura 60; normalmente estas grapas 100 estarían deformadas contra la superficie de yunque 74 de la mandíbula superior 48. La Figura 60 ilustra dos filas de grapas 100 configuradas de forma tal que la longitud de las bases 104 de la grapa así como la longitud de los canales 53 son paralelas al eje longitudinal del efector terminal 18. De manera similar, los compartimientos de grapas 108 (no se muestran en la Figura 60) en la mandíbula superior 48 están orientados paralelos al eje longitudinal del efector terminal 18. Las aberturas de salida de los canales 53 son paralelas y están alineadas con las aberturas de salida adyacentes de la fila adyacente de aberturas de salida. En otra variación, las aberturas de salida de los canales 53 en la mandíbula inferior 50 están escalonadas con respecto a las aberturas de salida adyacentes de la fila adyacente.Figures 57-59 are semi-transparent cross-sectional views of end effector 18 with the upper and lower jaws 48, 50 in a closed position taken perpendicular to the longitudinal axis in three progressive stages of staple deployment. Figure 57 shows four double row staples 100 residing in two circumferential staple receiving channels 53 on either side of the I-beam 32. The base 104 of each staple 100 is in contact with the upper surface 60 of the pusher 58 As the I-beam 32 is advanced, the pusher 58 will move the staples 100 along the circumferential path up and out from the lower jaw 50 and into the gap between the upper jaw 48 and the lower jaw 50. as shown in Figure 58. Figure 58 illustrates the legs of the staple 102, in particular the tips of the legs 106 approaching the anvil surface 74. The anvil surface 74 is shown in Figures 57- 59 to be provided with staple-forming compartments 108 that aid in deflection and deformation of the legs of the staple 102 from the base of the staple 104. Each staple compartment 108 includes a staple contact surface to 110 which is substantially perpendicular to the circumference of the staple channels 53 such that a curved staple 100 exiting a circumferential channel 53 contacts the contact surface of the staple 110 in a perpendicular orientation. Further advancement of the I-beam 32 in the distal direction moves the pushers 58 on either side of the I-beam 32 and their respective staples 100 through further circumferential channels 53 and up against the staple compartments 108 on the anvil surface 74 and in a deformed configuration as shown in Figure 59. Figure 59 illustrates a fully formed staple 100 that resides in the gap between the upper jaw 48 and the lower jaw 50. The gap provides space to receive the target tissue. Figure 60 illustrates end effector 18 with I-beam 32 partially advanced along end-effector 18. Two rows of double row staples 100 are shown on either side of I-beam 32 at various stages of deployment. . Staples 100 are shown to emerge from channels 53 of the staple in the lower jaw 50. Staples 100 that are located distally of the I-beam 32 have only partially emerged or have not yet emerged from channels 32 relative to staples 100 proximal to I-beam 32. For clarity, clips 100 located proximal to I-beam 32 are not shown deformed in Figure 60; normally these staples 100 would be deformed against the anvil surface 74 of the upper jaw 48. Figure 60 illustrates two rows of staples 100 configured such that the length of the staple bases 104 as well as the length of the channels 53 are parallel to the longitudinal axis of the end effector 18. Similarly, the staple compartments 108 (not shown in Figure 60) in the upper jaw 48 are oriented parallel to the longitudinal axis of the end effector 18. The outlet openings of the channels 53 are parallel and aligned with the adjacent outlet openings of the adjacent row of outlet openings. In another variation, the outlet openings of the channels 53 in the lower jaw 50 are staggered with respect to the adjacent outlet openings of the adjacent row.
Con respecto a las Figuras 61-63, se muestra una variación de un efector terminal 18 para el despliegue de grapas de doble hilera 100 en el que solamente se proporciona una fila de grapas 100 en cualquiera de los lados de la viga en I 32 en la que la viga en I 32 está avanzada a lo largo de la longitud del efector terminal 18 estando las mandíbulas superior e inferior 48, 50 en una configuración cerrada. La Figura 61 ilustra las grapas 100 que surgen desde la mandíbula inferior 50 respecto al traslado de la viga en I 32. Las grapas 100 deformadas se muestran residentes en el hueco entre la mandíbula superior 48 y la mandíbula inferior 50 en la ubicación de la viga en I 32 y proximal a esta. Las grapas 100 no deformadas surgen de la mandíbula inferior 50 o están ocultas en esta en la ubicación de la viga en I 32 y distal a esta. La Figura 62 ilustra una vista en perspectiva superior, de sección parcial del efector terminal 18 estando la viga en I 32 avanzada a lo largo del canal 55 de la mandíbula inferior central que despliega y deforma las grapas 100 a lo largo de la trayectoria de avance. Las Figuras 61 y 63 ilustran compartimientos de grapas 108 en la mandíbula superior 48 que están alineados con los canales 53 de la grapa en la mandíbula inferior 50. Los compartimientos de grapas 108 incluyen dos superficies cóncavas adyacentes alineadas con cada pata de la grapa 102 saliente. Los compartimientos cóncavos 108 desvían las patas de la grapa 102 una hacia la otra desde una configuración de grapas esencialmente con forma de U no deformada en una configuración deformada que forma una configuración esencialmente con forma de B con las puntas 106 de la grapa apuntando hacia abajo hacia la base 104 de la grapa. Una única línea de grapas se forma en cualquiera de los lados del canal 55 de la mandíbula inferior. Estas líneas de grapas son paralelas al eje longitudinal del efector terminal 18 y las longitudes de las bases 104 de la grapa también están dispuestas de forma paralela al eje longitudinal y al canal de la viga en I. Las líneas de grapas adicionales en cualquiera de los lados del canal 55 central están dentro del alcance de la presente invención.With respect to Figures 61-63, a variation of an end effector 18 for deployment of double row staples 100 is shown in which only one row of staples 100 is provided on either side of the I-beam 32 at wherein the I-beam 32 is advanced along the length of the end effector 18 with the upper and lower jaws 48, 50 in a closed configuration. Figure 61 illustrates the staples 100 arising from the lower jaw 50 with respect to the translation of the I-beam 32. The deformed staples 100 are shown resident in the gap between the upper jaw 48 and the lower jaw 50 at the location of the beam. at I 32 and proximal to it. The undeformed staples 100 arise from or are concealed in the lower jaw 50 at the location of the I-beam 32 and distal thereto. Figure 62 illustrates a partially sectional, top perspective view of end effector 18 with I-beam 32 advanced along channel 55 of the central lower jaw that deploys and deforms staples 100 along the path of advancement. . Figures 61 and 63 illustrate staple compartments 108 in upper jaw 48 that are aligned with staple channels 53 in lower jaw 50. Staple compartments 108 include two adjacent concave surfaces aligned with each leg of projecting staple 102. . The concave compartments 108 bias the legs of the staple 102 towards each other from an essentially undeformed U-shaped staple configuration into a deformed configuration that forms an essentially B-shaped configuration with the tips 106 of the staple pointing downward. toward the base 104 of the staple. A single line of staples is formed on either side of the channel 55 of the lower jaw. These staple lines are parallel to the longitudinal axis of end effector 18 and the lengths of the staple bases 104 are also arranged parallel to the longitudinal axis and channel of the I-beam. Additional staple lines on either side of the central channel 55 are within the scope of the present invention. .
A medida que la viga en I 32 avanza distalmente a lo largo del efector terminal 18, la superficie de contacto 72 de la viga en I 32 hará contacto con los pulsadores 58 ubicados en los canales 53 que, a su vez, hará contacto con las grapas 54, 100 que también están dispuestas dentro de los canales 53 de la grapa. A medida que la viga en I 32 avanza, los pulsadores 58 impulsarán a las grapas 54, 100, hacia arriba y continuarán impulsándolas consecutivamente hacia arriba con un traslado distal de la viga en I 32.As the I-beam 32 advances distally along the end effector 18, the contact surface 72 of the I-beam 32 will make contact with the pushbuttons 58 located in the channels 53 which, in turn, will make contact with the staples 54, 100 which are also arranged within the channels 53 of the staple. As the I-beam 32 advances, the pushbuttons 58 will drive the staples 54, 100, upward and continue to drive them consecutively upward with a distal translation of the I-beam 32.
Con suficiente altura de despliegue, las patas de la grapa 78, 80, 102 entrarán en contacto con la superficie de yunque 74 de la mandíbula superior 48. En particular, las patas de la grapa harán contacto con la superficie de yunque 74 en la ubicación de los compartimientos de la grapa 108 y con un mayor despliegue resultará en la torsión de las patas de la grapa en la configuración cerrada deseada capturando tejido dentro de la grapa. La fuerza de cierre de la grapa 54 de la presente invención es, de forma ventajosa, relativamente baja dado que las patas 78, 80, 102 en las variaciones de cuatro hileras y de doble hilera ya tienen configuraciones curvas o ligeramente torsionadas y se doblan simplemente contra la superficie de yunque 74 en oposición a ser forzadas a pandeo contra la superficie de yunque. Las fuerzas de pandeo de una viga son mucho mayores que las fuerzas de torsión y las grapas convencionales generalmente requieren el pandeo de patas de grapas simultáneamente. Los dispositivos de grapado convencionales requieren fuerzas de disparo elevadas para aplicar las líneas de las grapas. Las patas de la grapa son forzadas de forma perpendicular a los compartimientos de yunque forzándolas a pandeo. Estas fuerzas elevadas aplican tensiones significativas a los componentes del dispositivo y pueden causar fatiga al usuario. Por lo tanto, la presente grapadora reduce considerablemente las fuerzas requeridas para desplegar y deformar grapas. Las fuerzas formadoras de grapas de la presente invención son relativamente bajas cuando se comparan con diseños de grapas convencionales proporcionando fuerzas de accionamiento reducidas para el usuario.With sufficient deployment height, the legs of the staple 78, 80, 102 will contact the anvil surface 74 of the upper jaw 48. In particular, the legs of the staple will contact the anvil surface 74 at the location. staple compartments 108 and further deployment will result in twisting the staple legs into the desired closed configuration capturing tissue within the staple. The closing force of the staple 54 of the present invention is advantageously relatively low since the legs 78, 80, 102 in the four-row and double-row variations already have curved or slightly twisted configurations and are simply bent. against the anvil surface 74 as opposed to being forced to buckle against the anvil surface. The buckling forces of a beam are much greater than torsional forces and conventional staples generally require buckling of staple legs simultaneously. Conventional stapling devices require high firing forces to apply staple lines. The legs of the staple are forced perpendicular to the anvil compartments forcing them to buckle. These high forces place significant stresses on device components and can cause user fatigue. Therefore, the present stapler considerably reduces the forces required to unfold and deform staples. The staple forming forces of the present invention are relatively low when compared to conventional staple designs providing reduced actuation forces to the user.
A medida que la viga en I 32 se adelanta, una cuchilla en la viga en I 32 secciona tejido entre el tejido ya grapado. Luego de que se disparan las grapas, el ensamblaje de mango 12 se cambia al tercer modo de operación en el que la viga en I 32 vuelve proximalmente a su posición de comienzo. Se oprime un botón interruptor de engranaje que rota los grados del eje accionador 90 de forma tal que los dientes de reverso en el accionador entran en contacto con un propulsor reverso. El propulsor reverso está conectado al mango mediante una serie de engranajes.As the I-beam 32 advances, a knife on the I-beam 32 cuts tissue between the already stapled tissue. After the staples are fired, the handle assembly 12 is switched to the third mode of operation in which the I-beam 32 returns proximally to its home position. A gear switch button is depressed that rotates the actuator shaft 90 degrees such that the reverse teeth on the actuator contact a reverse drive. The reverse drive is connected to the handle by a series of gears.
Cuando se aprieta el mango, el propulsor reverso presiona el accionador y la viga en I 32 hacia atrás. El mango desencadenante se aprieta varias veces para hacer que la viga en I 32 vuelva a su posición original. La viga en I 32 vuelve a su posición proximal original para abrir las mandíbulas.When the handle is squeezed, the reverse drive pushes the actuator and I-beam 32 rearward. The trigger handle is squeezed several times to bring the I-beam 32 back to its original position. The I-beam 32 returns to its original proximal position to open the jaws.
Al estar la viga en I 32 de vuelta y totalmente retraída, la mandíbula superior 48 sesgada por resorte se abre permitiendo que el tejido grapado se libere desde las mandíbulas. Cuando el accionador y la viga en I 32 vuelven, el ensamblaje de cartucho de grapadora 14 se separa del ensamblaje de mango 12 y puede fijarse un nuevo ensamblaje de cartucho de grapadora 14 para un grapado continuo.With the I-beam 32 turned and fully retracted, the spring-biased upper jaw 48 opens allowing the stapled tissue to be released from the jaws. When the actuator and I-beam 32 return, the stapler cartridge assembly 14 is separated from the handle assembly 12 and a new stapler cartridge assembly 14 can be attached for continuous stapling.
Con respecto a las Figuras 64-65, se muestra una vista transversal del efector terminal 18 tomada de forma perpendicular al eje longitudinal con la viga en I 32 ubicada en la sección transversal. En la presente invención, se proporciona una grapadora que tiene un efector terminal 18 con un diámetro más pequeño, tal como en el intervalo de 5-10 mm, sin cambiar significativamente la capacidad que tiene la grapadora más pequeña de la presente invención de grapar tejido con el mismo grosor que una grapadora relativamente más grande, es decir, que mantenga sustancialmente el mismo ancho del hueco entre la mandíbula superior 48 y la mandíbula inferior 50. Esto se logra al emplear canales 53 de grapas circunferenciales en la mandíbula inferior 50 con grapas 54, 100 y pulsadores 58 configurados para funcionar dentro de los canales 53 circunferenciales. Los canales 53 circunferenciales toman ventaja de la distancia más larga transcrita por una distancia circunferencial dentro del perímetro externo de la sección transversal sustancialmente circular del efector terminal 18 respecto a una distancia más corta transcrita por una línea representada por la línea 7b que tiene una longitud SB que se muestra en la Figura 1B que es perpendicular a un cordón que representa la superficie superior de la mandíbula inferior 48. Para maximizar la longitud del segmento de línea circunferencial que está ubicado dentro del perímetro externo de la sección transversal y representativo de un canal 53 de grapas circunferencial, el canal 53 de grapas está ubicado de forma ventajosa lo más cerca posible del perímetro externo.Referring to Figures 64-65, a cross-sectional view of the end effector 18 is shown taken perpendicular to the longitudinal axis with the I-beam 32 located in cross-section. In the present invention, a stapler is provided having an end effector 18 with a smaller diameter, such as in the range of 5-10mm, without significantly changing the ability of the smaller stapler of the present invention to staple tissue. with the same thickness as a relatively larger stapler, that is, maintaining substantially the same width of the gap between the upper jaw 48 and the lower jaw 50. This is achieved by employing circumferential staple channels 53 in the lower jaw 50 with staples 54, 100 and pushbuttons 58 configured to operate within circumferential channels 53. Circumferential channels 53 take advantage of the longer distance transcribed by a circumferential distance within the outer perimeter of the substantially circular cross-section of end effector 18 over a shorter distance transcribed by a line represented by line 7b having a length SB shown in Figure 1B that is perpendicular to a chord representing the upper surface of the lower jaw 48. To maximize the length of the circumferential line segment that is located within the outer perimeter of the cross section and representative of a canal 53 of circumferential staples, the staple channel 53 is advantageously located as close to the outer perimeter as possible.
Dicha colocación del canal 53 de grapas más exterior permite que la línea de grapas interna que yace más cerca de la viga en I 32 se ubique más lejos de la línea de cuchilla diametral y también permite un canal 53 de grapas radialmente más exterior más largo para recibir una grapa con patas más largas para el grapado seguro de tejidos más gruesos. En grapas lineales tradicionales, la mandíbula inferior 50 comprende una mandíbula inferior externa 51 que forma un armazón semicilíndrico de grosor sustancial. Dentro del armazón de la mandíbula inferior externa 51, las grapas y pulsadores son residentes. Una de las funciones de la mandíbula inferior externa 51 distinta de formar un recipiente para las grapas es proporcionar rigidez estructural y fuerza a la mandíbula inferior de manera que cuando las grapas están desplegadas, la fuerza de accionamiento no agrieta, deforma o dobla la mandíbula inferior en sí. Por lo tanto, la mandíbula inferior externa 51 está hecha típicamente de plástico fuerte o metal de un determinado grosor. Este grosor de la mandíbula inferior externa 51 está reducido en la presente invención como se muestra en las Figuras 64-65 de forma tal que el canal 53 de grapas más exterior pueda ubicarse lo más cerca posible del perímetro para maximizar la longitud de la pata de la grapa que puede ubicarse en este así como maximizar la distancia del canal de grapas más interno fuera de la línea de cuchilla. Sin embargo, la mandíbula inferior externa 51 más fina sacrifica la fuerza y rigidez de la mandíbula inferior 50. Esta debilidad se resuelve en la presente invención al formar un marco 112 que está ubicado dentro de la mandíbula inferior externa 51 en una configuración tipo endoesqueleto en oposición a la configuración tipo exoesqueleto de grapas tradicionales en las que la mandíbula inferior externa 51 está hecha lo más gruesa posible para proporcionar rigidez estructural al efector terminal. El marco tipo endoesqueleto 112 de la presente invención puede ser parte de la mandíbula inferior interna 52 o estar separado de esta. El marco 112 tiene un grosor de aproximadamente 0,025 pulgadas y se extiende a lo largo de la longitud de la mandíbula inferior 50. El marco 112 está hecho de plástico fuerte o metal y forma la superficie superior 114 de la mandíbula inferior 50 desde la cual los canales 53 de grapas se abren y desde la cual salen las grapas. El marco 112 forma una configuración con forma de T sustancial que se divide hacia abajo en la línea media de la "T" por el canal 55 de la mandíbula inferior central en la que la viga 32 se traslada. La parte inferior 36 de la viga en I 32 es sustancialmente igual en ancho al ancho de la parte vertical de la "T" que comprende el ancho de dos marcos 112 y el ancho del canal 55 de la mandíbula inferior central como puede observarse en las Figuras 64-65. La parte inferior 36 de la viga en I 32 está interconectada a la parte superior 34 de la viga en I 32 por una parte media 38 de la viga en I 32. La parte media de la viga en I 32 es sustancialmente del mismo grosor que el grosor de un marco 112. El marco 112 con forma de "T" está formado por la yuxtaposición de dos elementos con forma de L separados entre sí por el canal 55 de la mandíbula inferior central. Las partes horizontales de los elementos con forma de L 116A, 116B o partes que son transversales a la viga en I 32 se extienden hacia el perímetro 118. En la variación que se muestra en las Figuras 64-65, el marco 112 tiene elementos 120 horizontales inclinados o transversales que forman un marco 112 esencialmente con forma de Y. Por lo tanto, los elementos 116 con forma de L forman ángulos obtusos en lugar de esencialmente ángulos rectos comunes en la forma T. Los elementos 120 transversales inclinados se extienden todo el recorrido hacia el perímetro 118 como se muestra en las Figuras 64-65. Los elementos 120 transversales incluyen un punto de inflexión en el que los elementos transversales inician la transición de ser perpendiculares a la parte media 38 de la viga en I 32 a ser inclinados con respecto a la parte media 38. Esta angulación del marco 112 proporciona más espacio dentro de la mandíbula inferior 50, en particular, adyacente al perímetro donde pueden alojarse patas de grapas más largas. En esta variación, la mandíbula superior 48 incluye un reforzamiento 122 dividido por la ranura central 76 en la mandíbula superior 48. El reforzamiento 122 de la mandíbula superior 48 incluye la superficie de yunque 74. La superficie de yunque 74 está generalmente inclinada de una manera que es paralela o se corresponde sustancialmente con el ángulo de la superficie superior 114 de la mandíbula inferior 50. El hueco para capturar tejido se define entre la superficie de yunque 74 y la superficie superior 114 de la mandíbula inferior 50. El reforzamiento 122 está hecho de metal o plástico.Such placement of the outermost staple channel 53 allows the inner staple line that lies closer to the I-beam 32 to be located further away from the diametrical knife line and also allows for a longer radially outermost staple channel 53 for receive a staple with longer legs for secure stapling of thicker fabrics. In traditional linear staples, the lower jaw 50 comprises an outer lower jaw 51 that forms a semi-cylindrical frame of substantial thickness. Within the outer lower jaw frame 51, the staples and pushers are resident. One of the functions of the outer lower jaw 51 other than forming a container for the staples is to provide structural rigidity and strength to the lower jaw so that when the staples are deployed, the actuation force does not crack, deform, or bend the lower jaw. per se. Therefore, the outer lower jaw 51 is typically made of strong plastic or metal of a certain thickness. This thickness of the lower outer jaw 51 is reduced in the present invention as shown in Figures 64-65 so that the outermost staple channel 53 can be located as close to the perimeter as possible to maximize the length of the staple leg that can be located in it as well as maximize the distance from the staple channel. innermost outside the blade line. However, the thinner outer lower jaw 51 sacrifices the strength and stiffness of the lower jaw 50. This weakness is resolved in the present invention by forming a frame 112 that is located within the outer lower jaw 51 in an endoskeleton-like configuration in as opposed to the exoskeleton-like configuration of traditional staples in which the lower outer jaw 51 is made as thick as possible to provide structural rigidity to the end effector. The endoskeleton frame 112 of the present invention may be part of or separate from the lower inner jaw 52. The frame 112 is approximately 0.025 inches thick and extends along the length of the lower jaw 50. The frame 112 is made of strong plastic or metal and forms the upper surface 114 of the lower jaw 50 from which Staple channels 53 open and from which staples exit. Frame 112 forms a substantial T-shaped configuration that splits down the midline of the "T" by channel 55 of the central lower jaw in which beam 32 translates. The bottom 36 of the I-beam 32 is substantially equal in width to the width of the vertical portion of the "T" comprising the width of two frames 112 and the width of the channel 55 of the central lower jaw as can be seen in the Figures 64-65. The lower portion 36 of the I-beam 32 is interconnected to the upper portion 34 of the I-beam 32 by a middle portion 38 of the I-beam 32. The middle portion of the I-beam 32 is substantially the same thickness as the thickness of a frame 112. The "T" shaped frame 112 is formed by the juxtaposition of two L-shaped elements separated from each other by the channel 55 of the central lower jaw. The horizontal portions of the L-shaped elements 116A, 116B or portions that are transverse to the I-beam 32 extend toward the perimeter 118. In the variation shown in Figures 64-65, the frame 112 has elements 120 inclined or transverse horizontals that form an essentially Y-shaped frame 112. Thus, the L-shaped elements 116 form obtuse angles rather than essentially right angles common in the T-shape. The inclined transverse elements 120 extend all the way through. travel to perimeter 118 as shown in Figures 64-65. The transverse elements 120 include an inflection point at which the transverse elements begin the transition from being perpendicular to the median 38 of the I-beam 32 to being inclined relative to the median 38. This angulation of the frame 112 provides more space within the lower jaw 50, in particular, adjacent to the perimeter where longer staple legs can be accommodated. In this variation, upper jaw 48 includes stiffener 122 divided by central slot 76 in upper jaw 48. Upper jaw stiffener 122 includes anvil surface 74. Anvil surface 74 is generally inclined in a manner which is parallel to or substantially corresponds to the angle of the upper surface 114 of the lower jaw 50. The gap for capturing tissue is defined between the anvil surface 74 and the upper surface 114 of the lower jaw 50. The reinforcement 122 is made made of metal or plastic.
La Figura 65 ilustra los canales 53 de grapas formados en la configuración del efector terminal 18 de la Figura 64 con la configuración del marco 112 de tipo endoesqueleto. Se muestran dos canales 53 de grapas en cualquiera de los lados de la viga en I 32, un canal 53a más exterior y un canal 53b más interior. El canal 53a más exterior se aproxima de forma cercana al perímetro 118 y está ubicado adyacente a la mandíbula inferior externa 51 que tiene un radio de curvatura que es aproximadamente el mismo que el radio de curvatura del perímetro 118 de la mandíbula inferior 50. El canal más interno 53b tiene un radio de curvatura que es mayor que el radio de curvatura del canal más exterior 53a. La superficie superior 114 de la mandíbula inferior 50 y la superficie de yunque 74 están sustancialmente paralelas entre sí de forma tal que las grapas que salen de los canales 53a, 53b estarán orientadas de forma tal que las patas de la grapa están sustancialmente perpendiculares a la superficie de yunque 74. Los elementos transversales inclinados 120 del marco 112 están inclinados de forma ventajosa hacia arriba maximizando así el espacio de la mandíbula inferior interna 52 y longitud de los canales 53, en particular la longitud del canal 53a más exterior que aloja el uso de grapas con patas más largas para grapar tejido a lo largo del hueco entre la superficie de yunque 74 y la superficie superior 114 de la mandíbula inferior 50.Figure 65 illustrates staple channels 53 formed in the configuration of end effector 18 of Figure 64 with the configuration of endoskeleton-like frame 112. Two staple channels 53 are shown on either side of the I-beam 32, an outermost channel 53a and an innermost channel 53b. The outermost canal 53a closely approximates the perimeter 118 and is located adjacent to the outer lower jaw 51 which has a radius of curvature that is approximately the same as the radius of curvature of the perimeter 118 of the lower jaw 50. The canal innermost channel 53b has a radius of curvature that is greater than the radius of curvature of the outermost channel 53a. The upper surface 114 of the lower jaw 50 and the anvil surface 74 are substantially parallel to each other such that the staples exiting the channels 53a, 53b will be oriented such that the legs of the staple are substantially perpendicular to each other. anvil surface 74. The inclined transverse elements 120 of the frame 112 are advantageously inclined upwards thus maximizing the space of the inner lower jaw 52 and length of the channels 53, in particular the length of the outermost channel 53a that houses the use stapler with longer legs for stapling tissue along the gap between the anvil surface 74 and the upper surface 114 of the lower jaw 50.
La Figura 66A ilustra otra variación del efector terminal 18 que maximiza el espacio de la mandíbula inferior interna 52 y la longitud de los canales 53 de grapas mientras que proporciona una configuración para reforzar el efector terminal 18 con una mandíbula inferior externa 51 más fina. En la variación de la Figura 66A, el reforzamiento para evitar que el efector terminal 18 se doble o se separe se encuentra en la configuración de la viga en I 32, en particular, la configuración de la parte superior 34 y la parte inferior 36 de la viga en I 32. La parte superior 34 y la parte superior 36 de la viga en I 32 tienen extremos distales laterales bulbosos o alargados 124, 126, respectivamente. La parte superior 34 de la viga en I 32 se traslada dentro de una ranura central 76 de la mandíbula superior que se ajusta para corresponderse con los extremos distales bulbosos alargados 124. Además, la parte inferior 36 de la viga en I 32 se traslada dentro de un canal 55 de la mandíbula inferior central que se ajusta para corresponderse con los extremos distales bulbosos alargados 126. Estos extremos distales laterales bulbosos alargados 124, 126 refuerzan el efector terminal 18 manteniéndolo junto cuando se aplican las fuerzas de accionamiento. Otras variaciones de la viga en I 32 se muestran en las Figuras 66B-66D. Las variaciones de las Figuras 66B-66D ilustran las partes superior e inferior 34, 36 de la viga en I 32 con dientes que se extienden fuera del perímetro externo para proporcionar un grosor aumentado y mejora de la fuerza lateral. La Figura 66A ilustra una superficie de yunque 74 curva que es convexa desde el punto de vista del hueco y una superficie superior 114 curva de la mandíbula inferior 50 que es cóncava desde el punto de vista del hueco. En la variación que se muestra en la Figura 66A, el radio de curvatura de la superficie superior 114 de la mandíbula inferior 50 es sustancialmente la misma que el radio de curvatura de la superficie de yunque 74 excluyendo cualquier formación de compartimiento de yunque y curvaturas. La superficie superior 114 curva de la mandíbula inferior 50 proporciona de forma ventajosa más espacio en la mandíbula inferior 52 interna particularmente cerca del perímetro 118 donde debido a la curvatura cóncava de la superficie superior 114 se proporciona más espacio para recibir grapas con patas más largas. Además, las patas de la grapa que salen de los canales 53 en la superficie superior 114 se dirigen sustancialmente perpendicularmente contra la superficie de yunque 74 debido a los radios de curvatura coincidentes de la superficie superior 114 y la superficie de yunque 74. En una variación, los radios de curvatura de la superficie superior 114 y la superficie de yunque 74 igualan también sustancialmente el radio de curvatura del perímetro 118.Figure 66A illustrates another variation of end effector 18 that maximizes inner lower jaw 52 spacing and length of staple channels 53 while providing a configuration to reinforce end effector 18 with a thinner outer lower jaw 51. In the variation of Figure 66A, the reinforcement to prevent the end effector 18 from bending or separating is in the configuration of the I-beam 32, in particular, the configuration of the top 34 and the bottom 36 of I-beam 32. Top 34 and top 36 of I-beam 32 have bulbous or elongated lateral distal ends 124, 126, respectively. The upper portion 34 of the I-beam 32 translates into a central groove 76 of the upper jaw that adjusts to correspond with the elongated bulbous distal ends 124. In addition, the lower portion 36 of the I-beam 32 translates into of a channel 55 of the central lower jaw that adjusts to correspond to the elongated bulbous distal ends 126. These elongated bulbous lateral distal ends 124, 126 reinforce the end effector 18 by holding it together when driving forces are applied. Other variations of the I-beam 32 are shown in Figures 66B-66D. The variations of Figures 66B-66D illustrate the upper and lower portions 34, 36 of the I-beam 32 with teeth extending outside the outer perimeter to provide increased thickness and improved lateral force. Figure 66A illustrates a curved anvil surface 74 that is convex from the point of view of the gap and a curved upper surface 114 of the lower jaw 50 that is concave from the point of view of the gap. In the variation shown in Figure 66A, the radius of curvature of the upper surface 114 of the lower jaw 50 is substantially the same as the radius of curvature of the anvil surface 74 excluding any compartment formation. anvil and curvatures. The curved upper surface 114 of the lower jaw 50 advantageously provides more space in the inner lower jaw 52 particularly near the perimeter 118 where due to the concave curvature of the upper surface 114 more space is provided to receive staples with longer legs. Furthermore, the staple legs emerging from channels 53 in upper surface 114 are directed substantially perpendicularly against anvil surface 74 due to the coincident radii of curvature of upper surface 114 and anvil surface 74. In a variation , the radii of curvature of upper surface 114 and anvil surface 74 also substantially equal the radius of curvature of perimeter 118.
Con respecto a las Figuras 67-69, se describirá otra variación del efector terminal 218. El efector terminal 218 incluye una mandíbula superior 248 abisagrada a una mandíbula inferior 250. Cuando las mandíbulas 248, 250 están en una orientación cerrada, forman una sección transversal sustancialmente circular. La mandíbula inferior 250 incluye un alojamiento de grapas o cartucho de grapas 252 que contiene múltiples grapas 254. La mandíbula inferior 250 comprende un armazón semicilíndrico hueco o mandíbula inferior externa (no se muestra) y una mandíbula inferior interna con forma acorde o cartucho 252 dispuesto dentro de la mandíbula inferior externa. La mandíbula inferior interna 252 puede o no removerse y reemplazarse como un cartucho para introducir más grapas 254 para un disparo continuo. En una variación en la que la mandíbula inferior interna 252 esté fija, toda la grapadora 10 es descartable luego de un único disparo o, de manera alternativa, el ensamblaje de cartucho de grapadora 14 funciona como un cartucho descartable y se remueve y reemplaza para un disparo continuo. La mandíbula inferior interna 252 incluye un marco 247 que define múltiples canales 253 o trayectorias de grapas configuradas para recibir grapas 254 y funciona como una guía para suministrar las grapas 254 hacia la mandíbula superior 248. Cada canal 253 forma una abertura superior en la superficie superior de la mandíbula inferior 250 a través de la cual una grapa 254 sale de la mandíbula inferior 250. La mandíbula inferior interna 252 incluye un canal central 255 que se extiende longitudinalmente y está configurado para recibir un deslizador 232 de la viga en I longitudinalmente trasladable. Cada canal 253 se extiende entre la abertura superior y una abertura inferior en la superficie superior de la mandíbula inferior 250. La abertura inferior está en comunicación con múltiples nervaduras que forman el marco 247. En la variación que se muestra en las Figuras 67-69, hay dos filas de canales 253 de grapas en cualquiera de los lados del canal 255 central. Las dos filas, una fila interna y una fila externa de canales 253 de grapas en un lado del canal central están configuradas de forma tal que están escalonados y no alineados entre sí para formar un cierre de tejido sellado. Las dos filas, una fila interna y una fila externa de canales 253 de grapas en el otro lado del canal 255 central también están escalonadas como se muestra. A lo largo del eje longitudinal, los canales 253 de grapas que comprenden la fila interna se definen longitudinalmente por múltiples nervaduras internas 239 que se extienden desde la superficie superior. Los canales 253 de grapas que comprenden la fila externa están longitudinalmente unidos y definidos por múltiples nervaduras externas 241 separadas a lo largo de la longitud de la mandíbula inferior 250. Las nervaduras externas 241 están conectadas a una columna 237 del marco 247 en la parte inferior de la mandíbula inferior 250. Cada canal 253 proporciona una trayectoria curva o arco desde la abertura superior del canal para guiar una grapa 254 curva colocada dentro de este. En una sección transversal tomada perpendicular al eje longitudinal del efector terminal 218, los canales 253 definen una trayectoria curva que tiene un radio de curvatura que sustancialmente coincide con el radio de curvatura de la mandíbula inferior externa y cada canal 253 forma una trayectoria de suministro circunferencial para la grapa 254. En una variación, los canales 253 son concéntricos alrededor del punto central de una sección transversal tomada perpendicular al eje longitudinal de las mandíbulas cerradas 248, 250. Una grapa de doble hilera 254 se muestra residiendo en los canales 253. Un pulsador interno 256 se muestra dispuesto dentro de cada uno de los canales 253 de la fila interna y un pulsador externo 258 se dispone dentro de cada uno de los canales 253 de la fila externa.With reference to Figures 67-69, another variation of end effector 218 will be described. End effector 218 includes an upper jaw 248 hinged to a lower jaw 250. When jaws 248, 250 are in a closed orientation, they form a cross section. substantially circular. The lower jaw 250 includes a staple housing or staple cartridge 252 containing multiple staples 254. The lower jaw 250 comprises a hollow semi-cylindrical frame or outer lower jaw (not shown) and a chord-shaped inner lower jaw or cartridge 252 arranged inside the outer lower jaw. The inner lower jaw 252 may or may not be removed and replaced as a cartridge to insert more staples 254 for continuous firing. In a variation in which the inner lower jaw 252 is fixed, the entire stapler 10 is disposable after a single shot or, alternatively, the stapler cartridge assembly 14 functions as a disposable cartridge and is removed and replaced for a continuous shooting. The inner lower jaw 252 includes a frame 247 that defines multiple channels 253 or staple paths configured to receive staples 254 and functions as a guide to supply the staples 254 toward the upper jaw 248. Each channel 253 forms an upper opening in the upper surface of the lower jaw 250 through which a staple 254 exits the lower jaw 250. The inner lower jaw 252 includes a longitudinally extending central channel 255 and is configured to receive a longitudinally translatable I-beam slider 232. Each channel 253 extends between the upper opening and a lower opening in the upper surface of the lower jaw 250. The lower opening is in communication with multiple ribs that form the frame 247. In the variation shown in Figures 67-69 , there are two rows of staple channels 253 on either side of the center channel 255. The two rows, an inner row and an outer row of staple channels 253 on one side of the center channel are configured such that they are staggered and not aligned with each other to form a sealed tissue closure. The two rows, an inner row and an outer row of staple channels 253 on the other side of the center channel 255 are also staggered as shown. Along the longitudinal axis, the staple channels 253 comprising the inner row are defined longitudinally by multiple inner ribs 239 extending from the top surface. The staple channels 253 comprising the outer row are longitudinally joined and defined by multiple outer ribs 241 spaced along the length of the lower jaw 250. The outer ribs 241 are connected to a column 237 of the frame 247 at the bottom of the lower jaw 250. Each channel 253 provides a curved path or arc from the upper opening of the channel to guide a curved staple 254 positioned within the channel. In a cross section taken perpendicular to the longitudinal axis of end effector 218, channels 253 define a curved path having a radius of curvature that substantially matches the radius of curvature of the lower outer jaw and each channel 253 forms a circumferential delivery path. for staple 254. In a variation, channels 253 are concentric about the center point of a cross section taken perpendicular to the longitudinal axis of closed jaws 248, 250. A double row staple 254 is shown residing in channels 253. A Internal pushbutton 256 is shown arranged within each of the channels 253 of the inner row and an external pushbutton 258 is arranged within each of the channels 253 of the outer row.
Con respecto a las Figuras 70-71, se describirá a continuación el pulsador interno 256. El pulsador interno 256 es curvo para adaptarse a la curvatura de los canales 253 de la grapa en el que se dispone. El pulsador interno 256 está configurado para hacer contacto con la superficie principal del deslizador de la viga en I 232 y, a su vez, hacer contacto con al menos una grapa 254. El pulsador interno 256 está configurado para interconectarse entre el deslizador de la viga en I 232 y una o más grapas 254. El pulsador interno 256 incluye una superficie superior 260 y una superficie inferior 262 interconectadas por una superficie externa 264 y una superficie interna 266 y dos superficies de extremo 268, 270. La superficie superior 260 está configurada para hacer contacto con una o más grapas 254 y como tal comprende una superficie de contacto de grapas. La superficie superior 260 del pulsador interno 256 incluye un canal 261 que tiene una superficie curva adaptada para sujetar y estabilizar la base de una grapa 254. La superficie externa 264 del pulsador interno 256 incluye un canal 265 que está configurado para recibir parte de una nervadura externa 241 que guía el movimiento hacia arriba del pulsador interno 256 a lo largo de su trayectoria curva cuando es movido por el deslizador 232 lo que evita que se desplace longitudinalmente. Entre la superficie interna 266 y la superficie externa 264, el pulsador interno 256 es más angosto hacia la superficie superior 260 y más ancho hacia la superficie inferior 262. El pulsador interno 256 se extiende longitudinalmente entre las dos superficies de extremo 268, 270. La superficie inferior 262 incluye un deslizador de la viga en I que hace contacto con la superficie 272 configurada para hacer contacto con la superficie principal 244 del deslizador de la viga en I 232. La superficie de contacto del deslizador de la viga en I 272 se moldea para ajustarse a la superficie principal 244. Si la superficie principal 244 del deslizador de la viga en I 232 tiene forma helicoidal, entonces la superficie de contacto 272 es también helicoidal. Se muestra a la superficie de contacto del deslizador 272 angular o biangular en las Figuras 73-76. La superficie interna 266 es ligeramente cóncava y la superficie externa 266 es ligeramente convexa. Ambas superficies externa e interna 264, 266 son sustancialmente concéntricas entre sí. En una variación, las superficies externa e interna 264, 266 son concéntricas con respecto al punto central de una sección transversal tomada perpendicular al eje longitudinal de las mandíbulas 248, 250 estando las mandíbulas 248, 250 en una configuración cerrada. En una variación, las superficies externa e interna 264, 266 tienen una curvatura que sustancialmente coincide con la curvatura del canal 253 en el que este se encuentra. En una variación, el canal 253 es circunferencial respecto a una sección transversal perpendicular al eje longitudinal de las mandíbulas 248, 250 estando las mandíbulas 248, 250 en una configuración cerrada y las superficies laterales 64, 66 del pulsador sustancialmente coinciden con la curvatura circunferencial. Las superficies de extremo 268 y 270 son sustancialmente paralelas y perpendiculares. Cuando es impulsado por el deslizador de la viga en I 232, cada pulsador interno 256 hace contacto con una grapa 254 y se desplaza de forma uniforme dentro de su canal 253 respectivo.With reference to Figures 70-71, the internal pusher 256 will now be described. The internal pusher 256 is curved to accommodate the curvature of the channels 253 of the staple in which it is disposed. Internal pushbutton 256 is configured to contact the main surface of the I-beam slider 232 and, in turn, make contact with at least one clip 254. Internal pushbutton 256 is configured to interconnect between the beam slider at I 232 and one or more staples 254. The internal pusher 256 includes an upper surface 260 and a lower surface 262 interconnected by an external surface 264 and an internal surface 266 and two end surfaces 268, 270. The upper surface 260 is configured for contacting one or more staples 254 and as such comprises a staple contact surface. The upper surface 260 of the inner pushbutton 256 includes a channel 261 that has a curved surface adapted to hold and stabilize the base of a staple 254. The outer surface 264 of the inner pushbutton 256 includes a channel 265 that is configured to receive part of a rib external 241 that guides the upward movement of internal pushbutton 256 along its curved path when moved by slider 232 which prevents it from moving longitudinally. Between the inner surface 266 and the outer surface 264, the inner pushbutton 256 is narrower toward the upper surface 260 and wider toward the bottom surface 262. The inner pushbutton 256 extends longitudinally between the two end surfaces 268, 270. The bottom surface 262 includes an I-beam slider that contacts surface 272 configured to contact major surface 244 of the I-beam slider 232. The contact surface of the I-beam slider 272 is molded to fit major surface 244. If major surface 244 of I-beam slider 232 is helical in shape, then contact surface 272 is helical as well. The angular or biangular slider contact surface 272 is shown in Figures 73-76. The inner surface 266 is slightly concave and the outer surface 266 is slightly convex. Both the outer and inner surfaces 264, 266 are substantially concentric with each other. In a variation, the outer and inner surfaces 264, 266 are concentric with respect to the center point of a cross section. taken perpendicular to the longitudinal axis of the jaws 248, 250 with the jaws 248, 250 being in a closed configuration. In a variation, the outer and inner surfaces 264, 266 have a curvature that substantially matches the curvature of the channel 253 in which it is located. In a variation, the channel 253 is circumferential with respect to a cross section perpendicular to the longitudinal axis of the jaws 248, 250 with the jaws 248, 250 being in a closed configuration and the pushbutton side surfaces 64, 66 substantially coincide with the circumferential curvature. End surfaces 268 and 270 are substantially parallel and perpendicular. When driven by the I-beam slider 232, each internal pusher 256 contacts a staple 254 and travels uniformly within its respective channel 253.
Con respecto a la Figura 72, se describirá a continuación el pulsador externo 258. El pulsador externo 258 es curvo para adaptarse a la curvatura de los canales 253 de la grapa en el que se dispone. El pulsador externo 258 está configurado para hacer contacto con la superficie principal del deslizador de la viga en I 232 y, a su vez, hacer contacto con al menos una grapa 254. El pulsador externo 258 está configurado para interconectarse entre el deslizador de la viga en I 232 y una o más grapas 254. El pulsador externo 258 incluye una superficie superior 259 y una superficie inferior 263 interconectadas por una superficie externa 275 y una superficie interna 277 y dos superficies de extremo 269, 271. La superficie superior 259 está configurada para hacer contacto con una o más grapas 254 y como tal comprende una superficie de contacto de grapas. La superficie superior 259 del pulsador externo 258 incluye un canal 273 que tiene una superficie curva adaptada para sujetar y estabilizar la base de una grapa 254. La superficie interna 277 del pulsador externo 258 incluye una proyección 257 que está configurada para colindar entre las superficies de extremo 268, 270 de pulsadores internos 256 adyacentes como se muestra en las Figuras 73, 74 y 75 evitando que el pulsador interno 256 se desplace longitudinalmente y, por lo tanto, ayude a guiar la trayectoria del pulsador interno 256. Entre la superficie interna 277 y la superficie externa 275, el pulsador externo 258 es más angosto hacia la superficie superior 259 y más ancho hacia la superficie inferior 263. El pulsador externo 256 se extiende longitudinalmente entre las dos superficies de extremo 269, 271. La superficie inferior 263 incluye un deslizador de viga en I que hace contacto con la superficie 279 configurada para hacer contacto con la superficie principal 244 del deslizador de viga en I 232. La superficie de contacto del deslizador de viga en I 279 se moldea para ajustarse a la superficie principal 244. Si la superficie principal 244 del deslizador de viga en I 232 tiene forma helicoidal, entonces la superficie de contacto 279 es también helicoidal. Se muestra a la superficie de contacto del deslizador 279 angular o biangular en las Figuras 72-76. La superficie interna 277 es ligeramente cóncava y la superficie externa 275 es ligeramente convexa. Ambas superficies externa e interna 275, 277 son concéntricas entre sí. En una variación, las superficies externa e interna 275, 277 son concéntricas con respecto al punto central de una sección transversal tomada perpendicular al eje longitudinal de las mandíbulas 248, 250 con las mandíbulas 248, 250 en una configuración cerrada. En una variación, las superficies externa e interna 275, 277 tienen una curvatura que sustancialmente coincide con la curvatura del canal 253 en el que este se encuentra. En una variación, el canal 253 es circunferencial respecto a una sección transversal perpendicular al eje longitudinal de las mandíbulas 248, 250 estando las mandíbulas 248, 250 en una configuración cerrada y las superficies externa e interna 275, 277 del pulsador externo 258 sustancialmente coinciden con la curvatura circunferencial. Las superficies de extremo 269 y 271 son sustancialmente paralelas y perpendiculares. Cuando es impulsado por el deslizador de viga en I 232, cada pulsador externo 258 hace contacto con una grapa 254 y se desplaza de forma uniforme dentro de su canal 253 respectivo. With reference to Figure 72, the external pushbutton 258 will now be described. The external pushbutton 258 is curved to accommodate the curvature of the channels 253 of the staple in which it is disposed. The external pushbutton 258 is configured to contact the main surface of the I-beam slider 232 and, in turn, make contact with at least one clip 254. The external pushbutton 258 is configured to interconnect between the beam slider. at I 232 and one or more staples 254. The outer pusher 258 includes an upper surface 259 and a lower surface 263 interconnected by an outer surface 275 and an inner surface 277 and two end surfaces 269, 271. The upper surface 259 is configured for contacting one or more staples 254 and as such comprises a staple contact surface. The upper surface 259 of the outer pushbutton 258 includes a channel 273 having a curved surface adapted to hold and stabilize the base of a staple 254. The inner surface 277 of the outer pushbutton 258 includes a projection 257 that is configured to abut between the surfaces of the pushbuttons. end 268, 270 of adjacent internal pushbuttons 256 as shown in Figures 73, 74 and 75 preventing internal pushbutton 256 from shifting longitudinally and thereby helping to guide the path of internal pushbutton 256. Between internal surface 277 and outer surface 275, outer pushbutton 258 is narrower toward upper surface 259 and wider toward lower surface 263. External pushbutton 256 extends longitudinally between the two end surfaces 269, 271. Bottom surface 263 includes a I-beam slider contacting surface 279 configured to contact main surface 244 of the slide r of I-beam 232. The contact surface of the I-beam slider 279 is molded to fit the major surface 244. If the major surface 244 of the I-beam slider 232 is helical in shape, then the contact surface 279 it is also helical. The angular or biangular slider contact surface 279 is shown in Figures 72-76. The inner surface 277 is slightly concave and the outer surface 275 is slightly convex. Both the outer and inner surfaces 275, 277 are concentric with each other. In a variation, the outer and inner surfaces 275, 277 are concentric with respect to the center point of a cross section taken perpendicular to the longitudinal axis of the jaws 248, 250 with the jaws 248, 250 in a closed configuration. In a variation, the outer and inner surfaces 275, 277 have a curvature that substantially matches the curvature of the channel 253 in which it is located. In a variation, the channel 253 is circumferential with respect to a cross section perpendicular to the longitudinal axis of the jaws 248, 250 with the jaws 248, 250 being in a closed configuration and the external and internal surfaces 275, 277 of the external pushbutton 258 substantially coincide with the circumferential curvature. End surfaces 269 and 271 are substantially parallel and perpendicular. When driven by the I-beam slider 232, each external pushbutton 258 contacts a staple 254 and travels uniformly within its respective channel 253.
Con referencia particular a las Figuras 73-75, puede observarse que la superficie principal 244 del deslizador de viga en I 232 inicialmente hace contacto con la superficie de contacto 272 del pulsador interno 256. La superficie de extremo opuesta 270 colindará la proyección 257 del pulsador externo 258. En particular, al menos una parte del grosor, aproximadamente la mitad del extremo inferior más ancho del pulsador interno 256 de la superficie de extremo 270 hará contacto con la proyección 257 del pulsador externo 258. Además, al menos una parte del grosor, aproximadamente la mitad del extremo inferior más ancho del pulsador interno 256 de la superficie de extremo 270 hará contacto con una nervadura interna 239 ubicada distalmente. Asimismo, la aplicación de la fuerza por el deslizador de viga en I 232 sobre la superficie de contacto 272 inclinada orientará el pulsador interno 256 hacia arriba hacia la superficie superior y forzará la grapa 254 a través de las aberturas 253. El pulsador interno 256 también se desplazará sobre la nervadura externa 241 tipo riel estando la nervadura externa 241 ubicada dentro del canal 265. El apoyo del pulsador interno 256 contra la nervadura interna 239, nervadura externa 241 y contra la proyección 257 estabiliza la posición del pulsador interno 256 cuando está en contacto con el deslizador de viga en I 232 y cuando el pulsador interno 256 es movido, proporciona una separación para que el deslizador de viga en I 232 se desplace distalmente y entre en contacto con un pulsador externo 258. Luego de que los pulsadores internos 256 en cualquiera de los lados del canal 255 central se apartan, la superficie principal 244 del deslizador de viga en I 232 hará contacto a su vez con la superficie de contacto 279 de pulsadores externos 258 adyacentes en cualquiera de los lados del canal 255 central. Tras el contacto con el pulsador externo 258, al menos una parte de la superficie de extremo distal 271 colindará la nervadura externa 241 y el pulsador externo 258 se orientará hacia arriba dentro del canal 253 moviendo la grapa 254 en la superficie superior 259 fuera del canal 253. Por lo tanto, la superficie principal 244 del deslizador de viga en I 232 se desplazará a lo largo de la longitud longitudinal de la mandíbula inferior 250 presionando un par de pulsadores internos 256 seguido de un par de pulsadores externos 258 secuencialmente y consecutivamente de forma repetida para desplegar las grapas 254 a lo largo del hueco entre la mandíbula superior 248 y la mandíbula inferior 250. Mientras solamente se muestra un segmento del efector terminal 215 que ilustra dos pulsadores internos 256 y dos pulsadores externos 258 en las figuras, el segmento se repite a lo largo de la longitud de la mandíbula inferior 250. With particular reference to Figures 73-75, it can be seen that major surface 244 of I-beam slider 232 initially contacts contact surface 272 of internal pushbutton 256. Opposing end surface 270 will abut pushbutton projection 257 258. In particular, at least a part of the thickness, approximately half of the lower wide end of the inner pushbutton 256 of the end surface 270 will make contact with the projection 257 of the outer pushbutton 258. In addition, at least a part of the thickness , approximately half of the lower, wider end of inner pushbutton 256 of end surface 270 will contact a distally located inner rib 239. Also, the application of force by the I-beam slider 232 on the inclined contact surface 272 will orient the internal pusher 256 upward toward the upper surface and will force the clip 254 through the openings 253. The internal pusher 256 also will move on the outer rail-like rib 241 with the outer rib 241 located within the channel 265. The bearing of the inner pushbutton 256 against the inner rib 239, outer rib 241 and against the projection 257 stabilizes the position of the inner pushbutton 256 when in contact with the I-beam slider 232 and when the internal pushbutton 256 is moved it provides clearance for the I-beam slider 232 to move distally and contact an external pushbutton 258. After the internal pushbuttons 256 On either side of the center channel 255 they move away, the major surface 244 of the I-beam slider 232 will in turn contact the sup contact surface 279 of adjacent external pushbuttons 258 on either side of the central channel 255. Upon contact with the outer pushbutton 258, at least a portion of the distal end surface 271 will abut the outer rib 241 and the outer pushbutton 258 will face up into the channel 253 moving the clip 254 on the upper surface 259 out of the channel. 253. Therefore, the main surface 244 of the I-beam slider 232 will be moved along the longitudinal length of the lower jaw 250 by pressing a pair of internal pushbuttons 256 followed by a pair of external pushbuttons 258 sequentially and consecutively by repeatedly to deploy staples 254 along the gap between upper jaw 248 and lower jaw 250. While only a segment of end effector 215 is shown illustrating two internal pushbuttons 256 and two external pushbuttons 258 in the figures, the segment repeats along the length of the lower jaw 250.
Con referencia continuada a las Figuras 73-77, el deslizador de viga en I 232 se describirá a continuación. El deslizador de viga en I 232 de las Figuras 73-76 es sustancialmente similar al deslizador de viga en I 32 de las Figuras 7-12. El deslizador de viga en I 232 incluye una parte superior 234 y una parte inferior 236 interconectadas por una parte media 238. La parte superior 234 incluye una parte superior curva. La parte media 238 incluye una cuchilla 242 que incluiría un borde principal afilado que se muestra como una superficie roma en las Figuras 73-76. En el extremo posterior, la parte media 238 incluye una parte para conectarse con la parte 30 de viga en I extendida como se muestra en la Figura 6. La parte posterior 236 encabeza el extremo frontal del deslizador de viga en I 232 e incluye una parte inferior curva con una superficie externa convexa y una superficie principal 244 que se asemeja a una quitanieves. La superficie principal 244 incluye dos superficies convergentes que se encuentran en una línea o punta vertical. Cada superficie convergente se extiende hacia afuera desde la punta en espiral helicoidal, es decir, no solo se extiende hacia arriba sino que da vueltas en espiral o se curva o rota con respecto al eje longitudinal del deslizador de viga en I 232 para crear el diseño de cuña en hélice. La vista en elevación frontal de la viga en I tiene sustancialmente forma de una letra mayúscula "I" con una parte curva inferior. La viga en I 232 se desliza longitudinalmente dentro del efector terminal 218 y como tal puede denominarse un deslizador. La viga en I/deslizador 232 está configurada para impulsar a las grapas fuera del efector terminal 218 a través de la superficie principal 244.With continued reference to Figures 73-77, the I-beam slider 232 will be described below. The I-beam slider 232 of Figures 73-76 is substantially similar to the I-beam slider 32 of Figures 7-12. The I-beam slider 232 includes an upper portion 234 and a lower portion 236 interconnected by a middle portion 238. The upper portion 234 includes a curved upper portion. The middle portion 238 includes a blade 242 that would include a sharp leading edge that is shown as a blunt surface in Figures 73-76. At the rear end, the middle portion 238 includes a portion for connecting with the extended I-beam portion 30 as shown in Figure 6. The rear portion 236 tops the front end of the I-beam slider 232 and includes a portion curved bottom with a convex outer surface and a main surface 244 that resembles a snowplow. Major surface 244 includes two converging surfaces that meet on a vertical line or point. Each converging surface extends outward from the helical spiral tip, that is, it not only extends upward but spirals or curves or rotates with respect to the longitudinal axis of the 232 I-beam slider to create the pattern. from wedge to helix. The front elevation view of the I-beam is substantially in the shape of a capital letter "I" with a curved bottom portion. I-beam 232 slides longitudinally within end effector 218 and as such may be referred to as a slider. I-beam / slider 232 is configured to drive staples out of end effector 218 through major surface 244.
Con respecto a las Figuras 78-79, una grapa de doble hilera 300 según la presente invención que es adecuada para uso con un efector terminal 218 como se describió en las Figuras 67-77, así como otras realizaciones encontradas en la presente memoria descriptiva. En las Figuras 78-79, la grapa de doble hilera 300 se muestra en su configuración no deformada o abierta. La grapa 300 incluye dos patas 302 interconectadas por una base 304. La base 304 funciona como una superficie de contacto para el acoplamiento con los pulsadores internos o externos 256, 258. Las patas 302 se extienden hacia arriba desde la base 304 y se curvan a un lado como se puede observar claramente en la Figura 79.With reference to Figures 78-79, a double row staple 300 according to the present invention that is suitable for use with an end effector 218 as described in Figures 67-77, as well as other embodiments found herein. In Figures 78-79, the double row staple 300 is shown in its undeformed or open configuration. Clamp 300 includes two legs 302 interconnected by base 304. Base 304 functions as a contact surface for engagement with internal or external pushbuttons 256, 258. Legs 302 extend upward from base 304 and curve to one side as can be clearly seen in Figure 79.
La curvatura de las patas de la grapa 302 corresponde a la curvatura de los canales circunferenciales 253 en los que se disponen y por los que se desplazan cuando son impulsadas por los pulsadores 256, 258 que entran secuencialmente en contacto con el deslizador de viga en I 232. Por lo tanto, la curvatura de las patas de la grapa 302 también corresponde sustancialmente a la circunferencia de la mandíbula inferior 250. El extremo de cada pata 302 está inclinado y forma una punta afilada 306. La punta 306 puede formarse de cualquier manera y puede tener cualquier otra forma geométrica que sea adecuada para perforar y penetrar tejido a través del cual se suministra la grapa 300.The curvature of the legs of the clip 302 corresponds to the curvature of the circumferential channels 253 in which they are arranged and through which they move when they are driven by the pushbuttons 256, 258 that sequentially come into contact with the I-beam slider. 232. Therefore, the curvature of the legs of the staple 302 also corresponds substantially to the circumference of the lower jaw 250. The end of each leg 302 is inclined and forms a sharp point 306. The point 306 can be formed in any way and may have any other geometric shape that is suitable for piercing and penetrating tissue through which the staple 300 is supplied.
Con respecto a las Figuras 80-84, se muestra la grapa 300 de las Figuras 78-79 en una segunda o deformada configuración luego del accionamiento completo de la grapadora. El despliegue de la grapa de doble hilera 300, resulta en que las patas 302 hagan contacto con la superficie de yunque de la mandíbula superior 248 y se deformen. Las patas 302 están desviadas entre sí de forma tal que las puntas 306 están inclinadas verticalmente hacia abajo hacia la base 304. Las patas 302 hacen contacto con la superficie de yunque en donde los compartimientos de yunque que están alineados con las aberturas de salida en la superficie superior de la mandíbula inferior 250 pueden formarse para guiar la deformación adecuada de las patas de la grapa 302. La grapa deformada 300 tiene una configuración esencialmente con forma de B y mantiene una curvatura tipo papa frita como se muestra en la Figura 84. Las patas 302 están desviadas sustancialmente en una dirección longitudinal a lo largo de la longitud del efector terminal 218.With reference to Figures 80-84, the staple 300 of Figures 78-79 is shown in a second or deformed configuration after complete actuation of the stapler. Deployment of the double row staple 300 results in the legs 302 contacting the anvil surface of the upper jaw 248 and deforming. Legs 302 are offset from each other such that tips 306 are slanted vertically downward toward base 304. Legs 302 make contact with the anvil surface where the anvil compartments that are aligned with the outlet openings in the upper surface of lower jaw 250 may be formed to guide proper deformation of the legs of staple 302. Deformed staple 300 has an essentially B-shaped configuration and maintains a potato chip curvature as shown in Figure 84. Legs 302 are substantially offset in a longitudinal direction along the length of end effector 218.
Con respecto a las Figuras 85-89, una grapa de doble hilera 310 según la presente invención que es adecuada para uso con un efector terminal 218 descrito en las Figuras 67-77, así como otras realizaciones encontradas en la presente memoria descriptiva. En las Figuras 85-89, la grapa de doble hilera 310 se muestra en su configuración no deformada o abierta. La grapa 310 incluye dos patas 312 interconectadas por una base 314. La base 314 funciona como una superficie de contacto para el acoplamiento con los pulsadores internos o externos 256, 258. Las patas 312 se extienden hacia arriba desde la base 314 y se curvan a un lado como se puede observar claramente en la Figura 89 definiendo un lado cóncavo y un lado convexo. La curvatura de las patas de la grapa 312 se corresponde con la curvatura de los canales 253 circunferenciales hacia los cuales se disponen y por los que se desplazan al ser impulsados por los pulsadores 256, 258 que entran secuencialmente en contacto con el deslizador de viga en I 232. Por lo tanto, la curvatura de las patas de la grapa 312 también corresponde sustancialmente a la circunferencia de la mandíbula inferior 250. El extremo de cada pata 312 forma una punta afilada 316. La punta 316 puede formarse de cualquier manera y puede tener cualquier otra forma geométrica que sea adecuada para perforar y penetrar tejido a través del cual se suministra la grapa 310.With reference to Figures 85-89, a double row staple 310 according to the present invention that is suitable for use with an end effector 218 described in Figures 67-77, as well as other embodiments found herein. In Figures 85-89, the double row staple 310 is shown in its undeformed or open configuration. Clamp 310 includes two legs 312 interconnected by base 314. Base 314 functions as a contact surface for engagement with internal or external pushbuttons 256, 258. Legs 312 extend upwardly from base 314 and curve to one side as can be clearly seen in Figure 89 defining a concave side and a convex side. The curvature of the legs of the clamp 312 corresponds to the curvature of the circumferential channels 253 towards which they are arranged and through which they move when driven by the pushbuttons 256, 258 that sequentially come into contact with the beam slider at 232. Therefore, the curvature of the legs of the staple 312 also corresponds substantially to the circumference of the lower jaw 250. The end of each leg 312 forms a sharp point 316. The point 316 can be formed in any way and can have any other geometric shape that is suitable for piercing and penetrating tissue through which staple 310 is supplied.
Con respecto a las Figuras 90-93, se muestra la grapa 310 de las Figuras 85-89 en una segunda o deformada configuración luego del accionamiento completo de la grapadora. El despliegue de la grapa de doble hilera 310, resulta en que las patas 312 hagan contacto con la superficie de yunque de la mandíbula superior 248 y se deformen. Las patas 312 están desviadas hacia una dirección para cerrar la curvatura deformada previamente en una configuración circular casi cerrada. Las puntas 306 están generalmente inclinadas verticalmente hacia abajo hacia la base 314. Las patas 312 hacen contacto con la superficie de yunque en donde los compartimientos de yunque que están alineados con las aberturas de salida en la superficie superior de la mandíbula inferior 250 pueden formarse para guiar la deformación adecuada de las patas de la grapa 312. Cada una de las patas 312 de la grapa deformada 310 tiene una configuración sustancialmente circular en la que cada configuración circular yace en un plano que es perpendicular a la base 314. Las patas 312 de la realización de la grapa 310 están desviadas lateralmente al eje longitudinal del efector terminal 218. With reference to Figures 90-93, staple 310 of Figures 85-89 is shown in a second or deformed configuration after complete actuation of the stapler. Deployment of the double row staple 310 results in the legs 312 contacting the anvil surface of the upper jaw 248 and becoming deformed. Legs 312 are biased in one direction to close the previously deformed curvature into a nearly closed circular configuration. Tips 306 are generally inclined vertically downward toward base 314. Legs 312 contact the anvil surface where the anvil compartments that are aligned with outlet openings in the upper surface of lower jaw 250 can be formed to guide the proper deformation of the legs of the staple 312. Each of the legs 312 of the deformed staple 310 has a substantially circular configuration in which each circular configuration lies in a plane that is perpendicular to the base 314. The legs 312 of the staple embodiment 310 are offset laterally to the longitudinal axis of the end effector 218.
Volviendo a las Figuras 67-68, se describirá a continuación la mandíbula superior 248 del efector terminal 218. La mandíbula superior 248 tiene forma sustancialmente semicilíndrica para ajustarse a un lumen cilíndrico de una cánula en la que se inserta. La mandíbula superior 248 incluye una ranura central 276 que se extiende longitudinalmente. La ranura central 276 tiene forma acorde y está configurada para recibir la parte superior 234 del deslizador de viga en I 232 y al menos una parte de la parte media 238 más angosta del deslizador de viga en I 232 de forma tal que el deslizador de viga en I 232 sea capaz de movimiento longitudinal respecto a la mandíbula superior 248 dentro y a lo largo de la ranura central 276. La ranura central 276 incluye un extremo proximal abierto que se inclina y se configura para leva contra el extremo frontal biselado del deslizador de viga en I 232.Returning to Figures 67-68, the upper jaw 248 of the end effector 218 will now be described. The upper jaw 248 is substantially semi-cylindrical in shape to fit a cylindrical lumen of a cannula into which it is inserted. The upper jaw 248 includes a central slot 276 that extends longitudinally. The central slot 276 is chord-shaped and configured to receive the upper portion 234 of the I-beam slider 232 and at least a portion of the narrower middle portion 238 of the I-beam slider 232 such that the I-beam slider at I 232 is capable of longitudinal movement relative to upper jaw 248 in and along central slot 276. Central slot 276 includes an open proximal end that slopes and is configured to cam against the beveled front end of the beam slider at I 232.
La mandíbula superior 248 está sesgada por resorte en una orientación abierta con respecto a la mandíbula inferior 250 y a medida que el extremo frontal biselado del deslizador de viga en I 232 entra en la ranura central 276 y, en particular, la parte superior 234 entra en el extremo superior más ancho de la ranura central 276, las mandíbulas superior e inferior 248, 250 son forzadas a cerrarse. El movimiento hacia adelante y atrás del deslizador de viga en I 232, hacia adentro y hacia afuera de la ranura central 276 o contra la abertura proximal de la ranura central 276, abre y cierra el efector terminal 218 lo que le permite al usuario retener y liberar tejido y la reposición de la grapadora 10. Al estar el efector terminal 218 en la configuración cerrada, el deslizador de viga en I 232 es capaz de un traslado longitudinal adicional dentro de la ranura central 276. Luego de la eyección de grapas 254, el deslizador de viga en I 232 se retrae proximalmente a través del ensamblaje de mango 12 y a medida que el deslizador de viga en I 232 sale de la ranura central 276, la mandíbula superior 248 sesgada por resorte se mueve en una orientación abierta.Upper jaw 248 is spring biased in an open orientation relative to lower jaw 250 and as the beveled front end of I-beam slider 232 enters central slot 276 and, in particular, upper portion 234 enters the wider upper end of the central slot 276, the upper and lower jaws 248, 250 are forced to close. The back and forth movement of the I-beam slider 232, in and out of the central slot 276 or against the proximal opening of the central slot 276, opens and closes the end effector 218 allowing the user to retain and releasing tissue and repositioning stapler 10. With end effector 218 in the closed configuration, I-beam slider 232 is capable of further longitudinal translation within central slot 276. Following staple ejection 254, I-beam slider 232 retracts proximally through handle assembly 12 and as I-beam slider 232 exits center slot 276, spring-biased upper jaw 248 moves in an open orientation.
Luego de la eyección de las grapas 254 y la retracción de la viga en I 232, se evita el traslado hacia adelante repetido del deslizador de viga en I 232 dentro de la ranura central 276 mediante un mecanismo de bloqueo para evitar el uso accidental de un cartucho ya disparado.Following ejection of staples 254 and retraction of the I-beam 232, repeated forward movement of the I-beam slider 232 into the central slot 276 is prevented by a locking mechanism to prevent accidental use of a cartridge already fired.
Además, con respecto a las Figuras 67-68, la mandíbula 248 incluye además una superficie de yunque interna 274 o placa que mira hacia la mandíbula inferior 250 y se separa de esta cuando está en la posición cerrada. La superficie de yunque 274 está configurada para recibir las patas de una grapa 254 y guiar, desviar, inclinar, doblar, ondular o cerrar las patas de la grapa a medida que la grapa 254 es impulsada a través de tejido contra la superficie de yunque 274. Para facilitar la formación de grapas 254 para asegurar tejido, se incluyen múltiples compartimientos formadores de grapas como se muestra en las Figuras 67-68 en la superficie de yunque 274. Estas formaciones de superficie de un yunque típico ayudan a la deformación de la grapa a medida que se despliega para lograr un cierre de grapa adecuado. Los compartimientos formadores de grapas se alinean con las aberturas de salida de los canales 253 en la mandíbula inferior 250. Los compartimientos formadores de grapas generalmente incluyen dos copas formadoras de patas de grapas adyacentes con una superficie de canalización curva o inclinada formada alrededor del perímetro de cada una de las copas formadoras de grapas. Las dos copas formadoras de patas de grapas adyacentes crean una forma de hueso de perro que facilita la formación de grapas con forma de B consistentes generalmente a partir de grapas no deformadas con forma de U en ángulo recto. Para impulsar lateralmente las patas de una grapa respecto a la base de la grapa como en la variación de la grapa que se muestra en las Figuras 85-93, se configura adecuadamente una superficie de yunque o compartimiento de grapas. Los compartimientos formadores de grapas independientes se proporcionan en cada ubicación formadora de grapas opuesta a los canales de cartucho 253 de la mandíbula inferior 250.In addition, with respect to Figures 67-68, the jaw 248 further includes an internal anvil surface 274 or plate that faces toward the lower jaw 250 and separates from it when in the closed position. Anvil surface 274 is configured to receive the legs of a staple 254 and guide, deflect, skew, bend, crimp, or close the legs of the staple as staple 254 is driven through tissue against anvil surface 274 To facilitate the formation of staples 254 to secure tissue, multiple staple-forming compartments as shown in Figures 67-68 are included in the anvil surface 274. These surface formations of a typical anvil aid in deformation of the staple. as it unfolds for proper staple closure. The staple-forming compartments align with the outlet openings of the channels 253 in the lower jaw 250. The staple-forming compartments generally include two adjacent staple-leg-forming cups with a curved or sloped channeling surface formed around the perimeter of each of the staple-forming cups. The two adjacent staple leg-forming cups create a dog bone shape that facilitates the formation of consistent B-shaped staples generally from right-angle U-shaped undeformed staples. To laterally drive the legs of a staple relative to the staple base as in the staple variation shown in Figures 85-93, a staple compartment or anvil surface is suitably configured. Separate staple-forming compartments are provided at each staple-forming location opposite the cartridge channels 253 of the lower jaw 250.
Como se describió anteriormente, la longitud de la pata de una grapa empleada en una grapadora quirúrgica convencional está generalmente limitada por una distancia perpendicular a la superficie superior 402 de la mandíbula inferior 404 que se representa por un segmento de línea 400 que es representativo de la longitud de una pata de la grapa en la Figura 94. Un extremo 401 del segmento de línea 400 es proximal a la superficie superior 402 de la mandíbula inferior 404 y el otro extremo 403 del segmento de línea 400 es proximal a la periferia inferior de la mandíbula inferior 404. La mandíbula inferior 404 se representa por un círculo parcial con un diámetro aproximado de 1,27 cm (0,5 pulgadas). La distancia desde la superficie superior 402 de la mandíbula inferior 404 al punto más distal en el círculo 404 al diámetro de la mandíbula inferior 404 es de aproximadamente 0,97 cm (0,38 pulgadas). Por lo tanto, como se representa en la Figura 94, la longitud del segmento de línea o de otro modo la longitud de una pata de la grapa 400 es de aproximadamente 0,86 cm (0,34 pulgadas), para una grapa con un diámetro de alambre fino de la pata de aproximadamente 0,25 cm (0,01 pulgadas) en un diseño de grapadora lineal convencional. En contraposición a una grapadora lineal de la Figura 94, se representa un esquema de una mandíbula inferior 414 de una grapadora circunferencial de la presente invención en la Figura 95 en donde la longitud de una pata de la grapa se define por una curva 400 en lugar de una línea recta dentro de la mandíbula inferior 414. Un extremo 411 de la pata de la grapa 410 está cerca de la superficie superior 412 de la mandíbula inferior 414 y el otro extremo 413 está cerca de la periferia inferior de la mandíbula inferior 414. El extremo 413 se encuentra en la misma ubicación que el extremo 403 de la Figura 94. La pata de la grapa 410 de la Figura 95 es curva y representa una grapa 410 que reside dentro de un canal curvo de una grapadora circunferencial según la presente invención. Dadas las mismas dimensiones para el diámetro de la mandíbula inferior (aproximadamente 0,127 cm (0,05 pulgadas)) y la misma distancia desde la superficie superior 412 al punto más exterior diametral en el círculo 414 de aproximadamente 0,97 cm (0,38 pulgadas), la pata de la grapa 410 tiene una longitud de aproximadamente 1,04 cm (0,41 pulgadas) en comparación con una pata de la grapa 400 con una longitud de solo aproximadamente 0,86 cm (0,34 pulgadas). Por lo tanto, la longitud de la pata de la grapa es de aproximadamente 20 % más larga en la presente invención. Por lo tanto, las ventajas de la presente invención son longitudes de grapas manifiestamente más largas que proporcionan la capacidad de grapar por completo y retener segmentos de tejido más grueso en una grapadora del mismo diámetro. As described above, the leg length of a staple employed in a conventional surgical stapler is generally limited by a distance perpendicular to the upper surface 402 of the lower jaw 404 which is represented by a line segment 400 that is representative of the length of a staple leg in Figure 94. One end 401 of line segment 400 is proximal to upper surface 402 of lower jaw 404 and the other end 403 of line segment 400 is proximal to the lower periphery of lower jaw 404. The lower jaw 404 is represented by a partial circle with a diameter of approximately 1.27 cm (0.5 inches). The distance from the upper surface 402 of the lower jaw 404 to the most distal point on the circle 404 to the diameter of the lower jaw 404 is approximately 0.97 cm (0.38 inches). Therefore, as depicted in Figure 94, the length of the line segment or otherwise the length of a leg of staple 400 is approximately 0.86 cm (0.34 inches), for a staple with a fine wire leg diameter of approximately 0.25 cm (0.01 inch) in a conventional linear stapler design. In contrast to a linear stapler of Figure 94, a schematic of a lower jaw 414 of a circumferential stapler of the present invention is depicted in Figure 95 where the length of a staple leg is defined by a curve 400 instead of a straight line within the lower jaw 414. One end 411 of the leg of the staple 410 is near the upper surface 412 of the lower jaw 414 and the other end 413 is near the lower periphery of the lower jaw 414. End 413 is in the same location as end 403 of Figure 94. The leg of staple 410 of Figure 95 is curved and represents a staple 410 that resides within a curved channel of a circumferential stapler in accordance with the present invention. . Given the same dimensions for the diameter of the lower jaw (approximately 0.127 cm (0.05 in)) and the same distance from the upper surface 412 to the outermost diametrical point on circle 414 of approximately 0.97 cm (0.38 inches), the leg of staple 410 is about 1.04 cm (0.41 inches) in length compared to a leg of staple 400 with a length of only about 0.86 cm (0.34 inches). Therefore, the length of the staple leg is about 20% longer in the present invention. Thus, the advantages of the present invention are markedly longer staple lengths that provide the ability to fully staple and retain thicker tissue segments in a stapler of the same diameter.
Volviendo ahora a la Figura 96, se muestra aun otro esquema de un diseño de grapadora circunferencial según la presente invención. La Figura 96 representa una longitud de la pata de la grapa 420 como una curva dentro de un esquema de una mandíbula inferior 424 de una grapadora. La pata de la grapa 420 tiene un extremo 421 cerca de la superficie superior 422 de la mandíbula inferior 424 y un segundo extremo 423 también cerca de la superficie superior 422 de la mandíbula inferior 424 para una longitud de la pata de la grapa total de aproximadamente 0,246 cm (0,097 pulgadas) que es significativamente más larga que la longitud de la grapa de las Figuras 94 y 95. La mandíbula inferior 424 se representa como un círculo parcial con un diámetro de aproximadamente 1,27 cm (0,5 pulgadas) y con una distancia desde la superficie superior 422 a un punto más exterior diametral en el círculo de aproximadamente 0,97 cm (0,38 pulgadas) que son las mismas dimensiones para la mandíbula inferior 424 como se representa en las Figuras 94 y 95. En esta variación, el diseño circunferencial saca ventaja del disparo a lo largo de casi toda la circunferencia de la mandíbula inferior 424 en contraposición a una distancia perpendicular en cualquiera de los lados de la línea media como se muestra en la Figura 94 o a lo largo de una parte de la circunferencia como se muestra en la Figura 95. La longitud de la grapa de la Figura 96 es de aproximadamente 285 % más larga que la grapadora convencional representada en la Figura 94 que ilustra la enorme ventaja en términos de una longitud de la pata de la grapa más larga proporcionada por diseños que comprenden disparo circunferencial según la presente invención.Turning now to Figure 96, yet another schematic of a circumferential stapler design in accordance with the present invention is shown. Figure 96 depicts a staple leg length 420 as a curve within a schematic of a lower jaw 424 of a stapler. Staple leg 420 has one end 421 near upper surface 422 of lower jaw 424 and a second end 423 also near upper surface 422 of lower jaw 424 for a total staple leg length of approximately 0.246 cm (0.097 inches) which is significantly longer than the length of the staple in Figures 94 and 95. The lower jaw 424 is depicted as a partial circle with a diameter of approximately 1.27 cm (0.5 inches) and with a distance from the upper surface 422 to a diametral outermost point on the circle of approximately 0.97 cm (0.38 inches) which are the same dimensions for the lower jaw 424 as depicted in Figures 94 and 95. In This variation, the circumferential design takes advantage of the shot along almost the entire circumference of the lower jaw 424 as opposed to a perpendicular distance on either side of the midline as shown shown in Figure 94 or along a portion of the circumference as shown in Figure 95. The length of the staple in Figure 96 is approximately 285% longer than the conventional stapler depicted in Figure 94 which illustrates the enormous advantage in terms of a longer staple leg length provided by designs comprising circumferential firing according to the present invention.
Las grapadoras laparoscópicas convencionales actualmente tienen un diámetro de aproximadamente 12 milímetros que requiere una cánula de mayor tamaño para la inserción y, por lo tanto, una incisión mayor en el paciente. La grapadora laparoscópica 10 de la presente invención con disparo giratorio tiene un diámetro de aproximadamente 0,508 cm a 1,01 cm (0,200 a 0,400 pulgadas) que se ajustará de forma ventajosa dentro de cánulas de diámetro más pequeño que requieren incisiones más pequeñas en el paciente mientras que al mismo tiempo tiene las mismas capacidades de grapar el tejido de igual grosor que las grapadoras más grandes. La grapadora circunferencial ofrece al menos un 20 % de reducción en tamaño del diámetro externo de la grapadora mientras suministra grapas con la misma longitud de la pata como en una grapadora de diámetro más grande con un diseño convencional. La incisión más pequeña da como resultado menos dolor, menos sangrado, tiempos de recuperación del paciente más rápidos y una cicatriz más pequeña visible luego de la operación. La grapadora de la presente invención es particularmente adecuada para procedimientos laparoscópicos; sin embargo, la invención no está tan limitada y la grapadora de la presente invención puede utilizarse en procedimientos quirúrgicos abiertos con igual efectividad. Conventional laparoscopic staplers currently have a diameter of approximately 12 millimeters which requires a larger cannula for insertion and therefore a larger incision in the patient. The laparoscopic stapler 10 of the present invention with rotary firing has a diameter of approximately 0.200 to 0.400 inches (0.508 cm to 1.01 cm) that will advantageously fit into smaller diameter cannulas that require smaller incisions in the patient. while at the same time having the same tissue stapling capabilities of the same thickness as larger staplers. The circumferential stapler offers at least 20% reduction in size of the stapler's outer diameter while supplying staples with the same leg length as a larger diameter stapler with a conventional design. The smaller incision results in less pain, less bleeding, faster patient recovery times, and a smaller visible post-operative scar. The stapler of the present invention is particularly suitable for laparoscopic procedures; however, the invention is not so limited and the stapler of the present invention can be used in open surgical procedures with equal effectiveness.
Se entiende que pueden realizarse diversas modificaciones a las realizaciones de la grapadora quirúrgica divulgada en la presente memoria. Por lo tanto, la descripción anterior no debería considerarse como limitante, sino simplemente como ilustraciones de las realizaciones preferidas. Los expertos en la materia contemplarán otras modificaciones dentro del alcance de la invención, como se define por las reivindicaciones. It is understood that various modifications can be made to embodiments of the surgical stapler disclosed herein. Therefore, the above description should not be construed as limiting, but merely as illustrations of the preferred embodiments. Those skilled in the art will envision other modifications within the scope of the invention, as defined by the claims.
Claims (13)
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EP (3) | EP3785644B1 (en) |
JP (4) | JP6674908B2 (en) |
ES (2) | ES2861258T3 (en) |
WO (1) | WO2015191887A1 (en) |
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EP3785644A1 (en) | 2021-03-03 |
US11666336B2 (en) | 2023-06-06 |
WO2015191887A1 (en) | 2015-12-17 |
US20210244413A1 (en) | 2021-08-12 |
EP3785644B1 (en) | 2023-11-01 |
JP2023123547A (en) | 2023-09-05 |
JP6674908B2 (en) | 2020-04-01 |
US20230263526A1 (en) | 2023-08-24 |
US20190175177A1 (en) | 2019-06-13 |
JP2017517346A (en) | 2017-06-29 |
JP2021121322A (en) | 2021-08-26 |
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